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ON THE 

CURABILITY OF CERTAIN FORMS OF 

INSANITY, EPILEPSY, CATALEPSY, 

AND 

HYSTERIA IN FEMALES. 



BT THE SAME AUTHOR, 
THIRD EDITION, 

In the press, and will be published immediately, 

ON SURGICAL DISEASES OF -WOMEN. 



CONTENTS. 

Chapter I. Laceration or Rupture of the Perinseum. 

II. Prolapse of the Vagina. 

III. Prolapse of the Uterus . 

IV. Vesico- vaginal Fistula. 
V. Recto-vaginal Fistula. 

VI. Lacerations and Cicatrices of the Vagina. 
VII. Tumours of the Uterus, Morbid Growths included. 
VIII. Operations on the Uterus. 
IX. Stone in the Female Bladder. 
X. Operations on the external Sexual Organs. 
XI. Diseases of the Rectum resulting from certain Conditions of 
the Uterus. 
XII. .Certain Diseases of the Rectum producing or simulating 

Uterine Disorder. 
XIII. Certain Surgical Diseases connected with Sterility in the 
Female. 



Also, preparing for publication, Second Edition of 

A TREATISE ON OVARIAN DROPSY ; 

Its Nature, Diagnosis, and Treatment, the result of Thirty 
Years' Experience. 

ON SCARLATINA: 

ITS NATURE AND TREATMENT. 
Second Edition, revised and enlarged. Fcap 8vo., price 3s. 



LONDON : ROBERT HARDWICKE, 192, PICCADILLY. 



ON THE CURABILITY 

OP CERTAIN FORMS OF 

INSANITY, EPILEPSY, CATALEPSY, 

AND 

HYSTERIA IN FEMALES. 



BY 



BAKER (BROWN, F.R.C.S. (Exam.) 

SENIOR 8UKOEON TO THF. LONDON SURGICAL IIOSfR ; 

LATB SURGEON-ACCOUCHEUR TO, AND LECTUBER ON MIDWIFERY AND UlbKASES OF 

TFOJIBN AND CHILDREN AT, ST, MJLItVH UOM'ITVL; 

LATB CONSULTING SURGEON TO TUB WE8TBQURNB DISPENSARY AND PABDLNGTGN LTUTG- 

1N CHARITY; 
PRESIDENT OF THE MEDICAL, SOCIETY OF LONDON ; 
FELLOW OF TBJH OBSTETRICAL SOCIETY OF LONDON; 
MBMBER OF THK MABVKIAN SOCIETY; 
CORRESPONDING FELLOW OP THE OBSTETRICAL HOCIETY OF BERLIN; 
HON. FELLOW OP TUB GENERAL ASSOCIATION DP BURGEONS, XORTHRRN GEKMa 
IttBX OF THE EHOOELYN MEDICAL AND SURGICAL SOCIETY; 
CORRESPONDING MEirBKit OP TUB SOCIETY OF MEDICAL HCIBWCB OP FBSTH ; 
CO B RESPONDING UEMBBR OP TBR SOCIETY OF MEDICAL SCIENCE OF BRUSSELS; 
CORRESPONDING MEMBER OF THE PHYSIQ-MBDICAL AMU STATISTICAL SOCIKTY OF MILAN 
HON. CORRESPONDING MEMBER OF THB MEDICAL SOCIETY OP NORWAY, J5TC. 



LONDON: 

BOBERT HARDWICKE, 192, PICCADILLY, W. 

1866. 



TOT AKt> HWUt, 

OBIFKTAL, CLAtSlCAL, AUD GKKIRAL PRINTERS, 

GREAT QUEEN STREET, W.C. 



^ 



' t Sr<eT 



« 



TO DR. E. BROWN-SEQTJARD, F.R.S., &e. 



Dear Dr. Brown-Sequard, 

I am deeply indebted for your kind per- 
mission to dedicate this work to you. I feel assured that its 
introduction to the Profession under the auspices of the greatest 
physiologist of the day will secure for it greater consideration, 
and lead to a closer examination of its contents, than would 
otherwise have been the case. 

With the greatest respect, believe me to be, 

Most faithfully yours, 

I. BAKER BROWN. 



17, Conn aught Square, Hyde Park, W. 
March, 1866. 



PREFACE. 



TN offering this little book to my profes- 
sional brethren, I do not for one moment 
wish it to be understood that I claim any 
originality in the surgical treatment herein 
described. 

Having read with great interest the Lectures 
on the " Physiology and Pathology of the 
Central Nervous System," delivered by Dr. 
Brown-Sequard before the Royal College of 
Surgeons of England, in 1858, and published 
in The Lancet> I was struck with a fact much 
insisted upon by the learned physiologist, 
namely, the great mischief which might be 
caused in the system generally, and in the 
nervous centres especially, by peripheral ex- 
citement. 



VI 



Constantly engaged In the treatment 
diseases of the female genitals, I had been often 
foiled in dealing successfully with hysterical 
and other nervous affections complicatin, 
these lesions, without being able to assign 
satisfactory cause for the failure. Dr. Brown 
S£quard's researches threw a new light on 
the subject, and by repeated observation 
was led to the conclusion that the cas< 
which had puzzled me, and defied my most 
carefully-conceived efforts at relief, depended 
on peripheral excitement of the pudic nerve. 
I at once subjected this deduction to a 
surgical test, by removing the cause of excite- 
ment. I have repeated the operation again 
and again, and it is the object of this book 
to show the results. 

Daily experience convinces me that all 
unprejudiced men must adopt, more or less, 
the practice which I have thus carried out ; 
and I have no doubt that, in properly 
selected cases, it will prove as successful 
in their hands as in mine. 



: 



' 




vu 



It will be observed that the majority of 
the cases I publish have been taken from 
the records of the London Surgical Home. 
I have drawn my illustrations chiefly from 
this source, because the practice of the 
Institution being freely open to the profes- 
sion, the cases have been observed by nu- 
merous medical men ; and, I may add, that 
many have become firm converts to my 
views. 



ON THE 
CURABILITY OF CERTAIN FORMS OF 

INSANITY, EPILEPSY, CATALEPSY, 

AND 

HYSTERIA IN FEMALES. 



CHAPTER L 



INTRODUCTORY. 



AS the title of ^is book implies, I do not intend 
to occupy the attention of my readers with all 
the numerous varieties of insanity and other nervous 
disorders to which females are liable, but only those 
which I believe to be curable by surgical means ; 
nor is it my intention in this category to include 
slight cases, bnt to confine myself to such as cause 
more or less severe functional derangement, or which 
lead to serious organic lesions. 

The class of diseases on which I shall dwell are 
those depending on {or arising from) a loss of 
nerve tone, caused by continual abnormal irritation 
of a nerve centre. 

This is no very new theory; but it has been for 
Dr. Handfield Jones, by a large number of cases and 
experiments, as collated in his admirable work on 
" Functional Nervous Disorders/ 1 * to make it " abun- 
dantly clear that the great majority of disorders we 
have to treat at the present time show more or less 



* London, Churchill, 1864. 




> 



Marked indications of failure of ne 
J- * r confines himself t( to such disorders 

^^ned functional ; " and I agree with him tl 
I a vain dispute, whether in strict a< 
l ° re are, or are not. any 8uch disorders; . 
s perfectly certain that there arc very gra 
. fal whicli the most careful scrutiny f 

. any actual change, in which complete « 

Jy J¥ [ fly possible, and in whicl^ the € juvant 

y £ * ** to operate more in modifying the p< 

^4^ ° P ^ auH iluiti the texture/' Dr. Jones thei 
T +> * Spiral cases of functional and organic c 

AT *•** ^jrC'un which, as he justly observes, "there 

^^^> & y ilJ "»4-oua instances of more or less 
i^V^** - # jrf 0T% *** and adds, that "disease which 
■ -' ' f * a f ^iffontfally as functional may end as or^ 

**-££**** ^^ ploaaed to be supported by my old 



;■ 



'%-- **, 



%..&' 



v 



;%r^ 



o iu views that I myself have long' 
intend, without further preface; 



g* *5U - ^ -s^ ^^ tll( 3 whole substratum of r 
' Jt ^ &^ show how, on the basis of 
N Q^ * j**^^ '/*t is possible to prove the 
^-^ gf -tctii 



tice. 
jfjrifi the tern* 8 * 
^ ^bs and I^ ter) 



inhibitor* 



I"*»„ A„*V*V >s and Us ter >' " re «»- 

^•- %• >*. * ^ 'nfc prf**" (B- 
r 



& 



y 6> 



1 



1' 



w 



/* is coded by ^ th at 
*?jf 0.^* ****** 



(Handheld Jones) , or, again, "an actually existing 
irritation " (Brown-Se*quard), exerts an injurious 
effect on its nerve centre, this state being, as Dr. 
Brown- Sequard thinks, increased or diminished ac- 
cording to the activity of the irritation, and ceasing 
with its entire removal, or, more probably, as Dr. 
Handiield Jones affirms, persisting after the cessation 
of the cause which has morbidly affected it. This 
latter view appears to me the more generally correct 
one, because it can hardly be expected that a gradual 
disease will be suddenly removed, there having been 
no time for recovery of nerve power. 

In Dr. Handheld Jones's Lumleian Lectures, deli- 
vered last year before the College of Physicians, he thus 
sums up his views on this subject : — " The essential 
idea of the inhibitory theory is, that an impression 
conveyed to a nervous centre by afferent nerves may 
weaken or paralyze, instead of exciting, its action, 
either from the congenital or acquired debility and 
sensitiveness of the nerve itself or because the im- 
pression is unduly intense or absolutely injurious. 
Both these things have in every case to be considered 
-viz,, the state of the nerve force, and the kind 
and amount of impression, as the resulting phenomena 
will vary with the variation of either.'" 

Dr. Jones next takes it as a matter of certainty, 
"that a nervous centre may be more or less com- 
pletely paralyzed without having undergone organic 
change, in consequence of some enfeebling morbid 



6 



influence;" and quotes from Dr. Gull* "a most 
interesting instance of complete paraplegia induced 
by sexual excess, in which nothing abnormal could 
be detected in the cord, even by careful microscopy. 
This was paralysis from simple exhaustion/' 

Still continuing, Dx\ Jones draws attention to 
anatomical fact of the remarkably close manner 
which " the different nerve centres, or parts of a nerve 
centre, are connected by commissural fibres," and 
how, " from a pathological point of view, the same 
connexion is often very manifest. The general ex- 
haustion induced by excess of venery/' and other 
cases, "are examples which show how excessiv 
consumption of nerve force in one part weakens it 
also in others; and this can only be adequately 
explained by the intricate commissural connexic 
between the various centres." 

The truth of all these views is well exemplified, as 
Dr. Kidd has stated, in cases of epilepsy, which ff may 
originate only in irritation of bad teeth acting on 
the brain, or worms irritating the nerves of the 
stomach, and so on as to other peripheral irritations ; 
the chief skill being to find out the spot from which 
the irritation radiates." 

A case is also quoted by Dr. Jones, in the Lumieian 
Lectures, as having occurred in the practice of 
Mr. Castle, of New York, where diseased teeth produced 
paraplegia, which soon ceased after their removal. 

* " Guy's Hospital Reports," 185a Case xviL 



Long and frequent observation convinced me that 
a large number of affections peooliar to females, de- 
pended on loss "of nerve power, and that this was 
produced by peripheral irritation, arising originally 
in some branches of the pudic nerve, more particu- 
larly the incident nerve supplying the clitoris, and 
sometimes the small branches which supply the 
vagina, perinseum, and anus. 

Closer observation satisfied me that the greater or 
less severity of the functional affections observed, de- 
pended on the amount and length of irritationj and the 
consequent amount of loss of nerve power. 

Nor are functional disorders the only consequence, 
but in some cases, severe organic lesions. 

The progress of the disease may be divided into 
eight distinct stages — -No. 8 being arrived at, by 
gradations more or less distinct, directly from No. 1. 



1* Hysteria (including dyspepsia and menstrual 
irregularities) . 

2. Spjnal Ikkitation, with reflex action on uterus, 
ovaries, etc., and giving rise to uterine displacement^ 
amaurosis, hemiplegia, paraplegia, &c. 

3. Epileptoid Fits, or Hysterical Epilepsy. 

4. Cataleptic Fits. 
Epileptic Fits. 

6. Idiotcy. 

7. Mania. 

8. Beats. 



8 



My statement, that death is indeed the direct 
climax of the aeries, might be proved by several cases 
which have occurred in my own practice, one only of 
which I shall relate. Before doing so, I may mention 
that Dr, James Russell, of Birmingham, has recorded 
a casein the Medical Times cmd Gazette, Oct. 31, 1863, 
in which a male patient, set. 32, died nnder his care 
in the Birmingham General Hospital. Complete 
paralysis both of sensation and motion in the lower 
part of the body and lower extremities attacked him 
after an unusually excessive venereal indulgence. 
There had been gradual exhaustion for the last twelve 
or fourteen years, from this cause. There was no 
attempt at recovery, and he died in four months 
from the date of the attack. 

The case that occurred in my own practice 

was as follows: , set. 19, has been gradually 

becoming ill since the age of nine ; does not look 
older than the latter age, though the sexual organs 
are as highly developed as they should be, Has 
been for many months in a metropolitan hospital 
suffering from acute headache, but has received no 
benefit, For two years has been perfectly blind 

She was found dead, and with every evidence o 
having expired during a paroxysm of abnormal ex- 
citement. 

These cases will illustrate how important it is 
arrest the disease ab initio , and the treatment mu: 
be the same whether we wish to cure functional 



; 



■ 




9 



disturbance, arrest organic disease, or, finally, if we 
have only a chance, of averting death itself. 

The time required for recovery must depend, not only, 
has been already hinted, on the duration of illness, 
it also on the peculiar temperament of the patient, 
and judicious after-treatment; this latter requiring 
long perseverance on the part of both practitioner 
and the friends of his patient; and it is as we 
meet a favourable or unfavourable case that the 
opinions of Brown -Sequard, as to instant cure on 
removal of irritation, or of Bandfield Jones, as to 
cure after a long interval, are verified. 

I have pleasure in stating that, with reference to 
the origin of most nervous affections of females, I 
have, in frequent conversation with Brown-S&juard, 
found that the views of this distinguished physiologist 
entirely coincide with my own, and he often expressed 
himself as satisfied that destruction of the nerv 
causing irritation was the only effective cure; the 
best mode of carrying out this destruction was, in 
his opinion, yet to be determined. He used actual 
cautery, 

I hope to be able to show that a far more 
humane and effectual method is that which I con- 
stantly practise, and for the last six or sewn years 
have openly and consistently advocated. Of course, 
from the very novelty of these views, I have been 
met with many objections, such as unsextng the 
female, preventing the normal excitement consequent 



10 



on marital intercourse, or actually, as some nn 
absurdly and unphilosophically assert, causing si 
rility ; whereas my cases will show fact to be directly 
converse to all these theories ; and it is curious that 
a physician for many years connected with one of 
our largest metropolitan hospitals, and recognized as 
a standard writer on female diseases, has in writing 
condemned my practice in not very measured terms, 
but is himself constantly in the habit of trying to 
subdue this peripheral irritation by continual appli- 
cation of the strongest caustics to the seat of the 
irritation j thereby showing that he recognizes the 
source of evil, but is not yet able to see that a 
superficial sore will not destroy deep-seated nerve 
irritation. It wants, I imagine, little argument to 
prove that so far from this practice being beneficial, 
it is likely, by causing increased irritation, .to be posi- 
tively injurious- 
Other practitioners follow Dr. Brown- Sequard J s plan 
of applying actual cautery to the irritant nerve ; and 
many more have advanced as far as the operation — 
which I was formerly in the habit of practising — sub- 
cutaneous division of the nerve . I have long abandoned 
this method as being no more certain in its effect than 
kindred operations on various branches of the fifi 
nerve for tic doloureux. 

Another objection has been made that several 
my cases have not been permanently cured, but have 
had relapses in a few weeks or months. This must 



ian 
fth 

IVr 

ast 

i 



11 

necessarily be so with all new methods of treatment ; 
but each such case is of incalculable importance, as 
teaching me to exclude any but temporary hope of 
relief to some, while to others I can speak all the 
more positively as to their ultimate permanent re- 
covery. 

Experience seems to teach that in those patients 
whose brains have been bo weakened by long con- 
tinued peripheral excitement, causing frequent and in- 
creasing losses of nerve force, there is not sufficient 
mental power to enable them to control any less power- 
ful irritation of smaller branches of the pudic nerve, 
than that removed by operation. 

This lesser excitement acts chiefly, I imagine, by 
preventing restoration, in the same manner as a 
drunkard whose brain is weakened by long indulgence 
in his baneful habit cannot resist temptation, but is, 
however, affected by much smaller quantities of 
stimuli, than when strong, he was able to take. 

A striking instance of this kind occurred to me last 
year. 

One of our most distinguished obstetric physicians 
requested me to operate on a lady who had been for 
some twenty years under very many eminent practi- 
tioners without any but temporary benefit, The 
result of the operation was most marked \ the irrita- 
tion subsided, the patient improved in health, and we 
confidently expected permanent relief. Yet in a few 
weeks after she left our hands and that of the nurse. 




12 



irritation, resembling pruritus, gradually returned, 
with it the other old symptoms. 

In all cases of a similar nature which have comi 
under my care, I have insisted on the importance of 
the patient being kept for a long time under careful 
medical watching and good nursing, and from the 
results already obtained from cases in which these 
precautions have been exercised, I feel confident 
success for the future* 

Lastly, objections have been advanced against 
morality of the operation, and I am here at a loss ~ 
to give an answer, for I can hardly conceive how such a 
question can be raised against a method of treatment 
which has for its object the cure of a disease, that is 
rapidly tending to lower the moral tone, and which 
treatment is dictated by the loftiest and most moral 
considerations. I may here observe, that before com- 
mencing treatment, I have always made a point o 
having my diagnosis confirmed by the patient or her 
friends. 

To the philosophical and charitable mind, indeed, 
the whole subject is one of the greatest interest, and 
will lead us to ask the question, may not this u inhibi- 
tory influence/* originating in early life, act so power- 
fully on the mind as to unhinge it from that steadiness 
which is essential to enable it to keep the passions 
under control of the will \ to enable, indeed, the moral 
tone to overcome abnormal excitement ? And if this 
be true, does not common charity lead us to think that 






13 

cases treated by friends and spiritual advisers, as con- 
trollable at the will of the individual, may be in reality 
simply cases of physical illness amenable to medical 
,nd surgical treatment ? Is it not better to look the 
matter steadily in the face, and instead of banishing 
the unhappy sufferers from their home and from society, 
endeavour to check their otherwise hopeless career 
towards some of the latter stages of this disease, to re- 
store their mental power, and make them happy and 
useful members of the community ? 

On this consideration I shall not now dwell further* 
Every one must feel it to be a vast and important one, 
affecting the well-being of the whole human race* 

All I am now aiming at, is to show that many, if not 
all, such cases may be cured* If this is done, I shall 
indeed be able to say that I am amply repaid. 

I have the gratification of being able to name the 
following gentlemen who have been led to adopt my 
views and treatment in proper cases : — Sir James 
Simpson ; Dr. Beat-tie, of Dublin ; Sir John Fife and 
Dr. Dawson, of Newcastle- on -Tyne ; Dr. Duke, late 
of Chichester; Dr. Shettle, of Shaftesbury; John 
Harrison, Esq., of Chester; Drs. Savage, Routh, and 
Rogers, in London ; my eldest son, Mr. Boyer Brown, 
now practising in New South Wales ; with my col- 
leagues in the u London Surgical Home/* Dr. Barratt, 
and Messrs. Harper, Chambers, I. B. Brown, junior, 
and Bantock, and very many others. 



14 



CHAPTER II. 

SYMPTOMS AND PROGRESS OP DISEASE — AGE AND CLASS 
OP PATIENTS TO BE TREATED OPERATION — AFTER- 
TREATMENT, ETC. 

EVERY medical practitioner must have met with 
a certain class of cases which has set at 
defiance every effort at diagnosis, bafHed every treat- 
ment, and belied every prognosis. He has expe- 
rienced great anxiety and annoyance, and felt how 
unsatisfactory was his treatment to the friends of 
his patient : and this, not so much because he was 
iguorant of the cause, as that he was unable to 
offer any hope of relief. 

The period when such illness attacks the patient 
is about the age of puberty, and from that time up 
to almost every age the following train of symptoms 
may be observed, some being more or less marked 
than others in the various cases. 

The patient becomes restless and excited, or 
melancholy and retiring; listless and indifferent to 
the socSal influences of domestic life. She will be 



fanciful in her food, sometimes express even a dis- 
taste for it, and apparently (as her friends will say) 
Kve npon nothing* She will always be ailing, and 
complaining of different affections. At first, perhaps, 
dyspepsia and sickness will be observed ; then pain 
in the head and down the spine ; pain, more or less 
constant, in the lower part of the back, or on either side 
in the lumbar region. There will be wasting of the face 
and muscles generally ; the skin sometimes dry and 
harsh, at other times cold and clammy. The pupil will 
b© sometimes firmly contracted, but generally much 
dilated. This latter symptom, together with a hard 
cord-like pulse, and a constantly moist palm, are, 
niy son informs me, considered by Mr* Moore, Co- 
lonial Surgeon of South Australia, pathognomonic 
of this condition. There will be quivering of the 
eyelids, and an inability to look one straight in the 
face. On inquiring further, there is found to be 
disturbance or irregularity in the uterine functions, 
there being either complete cessation of the cata- 
menia, or too frequent periods, generally attended with 
pain; constant leucorrhcea also frequently existing. 
Often a great disposition for novelties is exhibited, 
the patient desiring to escape from home, fond of be- 
coming a nurse in hospitals, u sceur de charite*," or 
other pursuits of the like nature, according to station 
and opportunities. 

To these symptoms in the single female will be 



added, in the married, distaste for marital intercourse, 
and very frequently either sterility or a tendency to 
abort in the early months of pregnancy. 

These physical evidences of derangement, if left i 
checked, gradually lead to more serious consequences. 
The patient either becomes a confirmed invalid, always 
ailing, and confined to bed or sofa, or, on the other 
hand, will become subject to catalepsy, epilepsy, 
idiotcy, or insanity. In any case, and more especially 
when the disease progresses as far as these latter 
stages, it will almost universally be found that there 
are serious exacerbations at each menstrual period. 

On personal examination, the peculiar straight and 
coarse hirsute growth ; the depression in the centre of 
the perineum ; the peculiar follicular secretion ; 
alteration of structure of the parts, mucous meinbr 
taking on the character of skin ; and muscle hm 
become hypertrophied and generally tending toward 
a fibrous or cartilaginous degeneration; will all be 
recognized by the practitioner who has once had 
attention drawn to these subjects. 

Having ascertained the cause and nature of 
disease, there are one or two points to be consider 
before operative measures are decided on. 

First, as to age. Although there is no doubt tha 
patients may suffer from peripheral irritation of 
pudic nerve from the earliest childhood, I never operate 
or sanction an operation on any patient under 
years of age, which is the earliest date of puberty 



17 



In children younger than this, milder treatment with 
careful watching, will be found sufficient if it be 
thoroughly persevered in. 

There are again, after puberty, cases which give 
rise to but slight disturbance, but in which the sufferers 
are they who love to enlist sympathy from the chari- 
table, and will be ill, or affect to be ill, in spite of any 
and every treatment. 

When I have decided that my patient is a fit subject 
for surgical treatment, I at once proceed to operate, 
after the ordinary preliminary measures of a warm 
bath and clearance of the portal circulation. 

The patient having been placed completely under the 
influence of chloroform, the clitoris is freely excised 
either by scissors or knife — I always prefer the scissors, 
The wound is then firmly plugged with graduated 
compresses of lint, and a pad, well secured by a T 
bandage. 

A grain of opium is introduced per rectum, the 
patient placed in bed, and most carefully watched by 
a nurse, to prevent haemorrhage by any disturbance 
of the dressing. The neglect of this precaution will 
be frequently followed by alarming haemorrhage, and 
consequent injurious results. 

The diet must be un stimulating, and consist of milk, 
farinaceous food, fish, and occasionally chicken ; all 
alcoholic or fermented liquors being strictly prohibited. 
The strictest quiet must be enjoined, and the attention 
of relatives, if possible, avoided, bo that the moral 



18 

influence of medical attendant and nurse may be un- 
interruptedly maintained. 

A month is generally required for perfect healing of 
the wound, at the end of which time it is difficult for 
the uninformed, or non-medical, to discover any trace 
of an operation. 

The rapid improvement of the patient immediately 
after removal of the source of irritation is most 
marked; first in the countenance, and soon after- 
wards by improved digestion and other evidences of 
healthy assimilation. 

It cannot be too often repeated, that this improve- 
ment can only be made permanent, in many cases, 
by careful watching and moral training, on the part of 
both patient and friends. 

In the large majority of cases, I have administered 
no medicines, trusting entirely to recovery, after the 
removal of the source of irritation. Sometimes, how- 
ever, we may be materially aided by the use of such 
medicines as the bromides of potassium and ammo- 
nium, belladonna, &c. 




CHAPTEE III. 

HYSTERIA, WITH CASES. 

% 

^T may, perhaps, be necessary before relating 

cases which I have treated, suffering from 

steria, to state briefly what I understand by this 

■*-m. The word Hysteria was doubtless originally 

^d in the belief that it depended on excessive 

flex action of the nerves of the uterus and ovaries, 

lien these organs were excited by disease or other 

^uses; bnt this view is a very limited one, for, as 

^r. Handfield Jones says, u it does not appear that 

finales suffering with irritable uterus are more 

hysterical, often not so much so, as those who have 

*to such disorder ." There is, however, as I have 

already mentioned; in almost all hysterical patients, 

8& exacerbation at the menstrual periods. 

Dr. Copland* s opinion, that " increased reflex 
excitability of the nerves of the female generative 
organs is one principal causative condition of hysterical 
^Sections," appears to me the correct one. Eomberg 
*ko says, "from the time when hysteria has taken 
>t, the reflex action preponderates throughout thf* 



20 

organism, and renders the individual more dependent 
upon external stimuli ." 

I have alluded in the last chapter to those patients 
who have no desire to get well. Such I am not con- 
sidering ; and although I believe that all the complaints 
of an hysterical patient are more or less exaggerated, 
my experience differs from that of Dr. Handheld 
Jones, who believes that such patients are not " bona 
fide anxions to get well/' In his view he is supported 
by Dr, Prout, who considers that u the whole ener- 
gies of the patient's mind are bent on deception ; " 
and by Dr. Watson, who says that " the deceptive 
appearances displayed in the bodily functions and 
feelings find their counterpart in the mental/' I am 
confident that I have met with many instances in 
which the nerve power has become so weakened that 
the patient, without having organic disease, really 
feels all the symptoms she describes, and is only too 
anxious to bo cured. The cases I shall now narrate 
are a few of a large number that have come under 
my care, and I am not without hope that their rela- 
tion may show that hysteria, instead of being a term 
of reproach, does truly represent a curable disease* 

The following was the first case that came under 
my notice, after I had satisfied myself of the correct- 
ness of iny views on the subject : — 



21 



}ase I. Hysteria— Five Years' Illness — Operation 
— Cuee in Two Months. 

D. E., jet. 26, single ; admitted into the London Surgical Home 
12, 1859, 

History. — She had been a dressmaker in Yorkshire to all the 
est fiimilies around, but for the last five years had been so ill as 

i render her unable to do any work, and had been entirely sup- 
orted by her former customers. When in that neighbourhood, on 

professional visit to a lady, I was requested to see, amongst 
thers, this poor ti-dwant dressmaker. Her physiognomy at once 
old me the nature of the case ; she was much attenuated, having for a 
;time been unable to retain any food, always being sick, with great 
ain, immediately after meals. She had constant acid eructations ; 
i so weak as to be at times unable to cross the room \ complained 

a burning, aching pain, with great weakness at the lower part of 
tie back. Her cat&inenia were irregular, with much leiicorrhtea ; 
owels generally costive. She was very melancholy, and expressed 
, most earnest desire to be cured. I advised her admission to the 
* Home," and on October 15, I divided the clitoris subcutaneously. 
my first operation, I did not know the consequences of 
erforming the operation in this manner. For two days the 

ernorrhage was profuse and uncontrollable. Sleep was procured 

r opiates. I ordered Jij of olive oil to be rubbed into her chest 
eery night, with a view to nutrition of her attenuated frame, A 
aoderately generous diet was given, but no stimulants. She was 

dte well in two months, and has never since had a day's illness. 

be resumed her occupation as a dressmaker, and recovered nearly 
Jl her former customers. 1865, — I have heard almost yearly of 
tie iit, and lately had a letter from the lady to whom I pre- 
viously referred, saying that my patient is perfectly well and in 
tfbnit heal Lb. 



22 



Case II. Two Teaks' Illness — Operation — Cuees. 

P. F. t set 21, single ; admitted into the London Surgical Home 
Jan. 7, 1861. 

lliatory. — Attributes her illness to having strained herself two 
years ago, when lifting a heavy saucepan from the fire. Ha 
*inoe that time suffered great pain in the back and side, much worse 
when she walks, but tolerably easy in the prone position. Cata- 
lnenia very irrefnilar, both as to time ami iin in 

defecation. .Bowels very constipated* Has been eleven weeks in 
a metropolitan general hospital, and thirteen weeks in a special 
hospital for women, from both of which she was discharged as 

ig nothing the matter, because she had no evident d 
She had, however, been treated for uterine disease. 

On- MJtt, the uterus was found to be quite healthy ; there 

was, however, evidence of excitation of the pudic nerve. 

Jan. 10. The clitoris completely excised. 

Jan. 16. Is much better. 

Jin, 31. \>± from the Home, cured. Is quite well 

in her health, having lost all aches and pains, and being able to 
defecate without the slightest uneasiness. 



Case III. Hysteria— Thirteen Tears' Illness— 
Sterility — Operation — Cure, aot subsequently 
Three Pkeonancies. 

S. S-, oet. 33, married ; admitted into the Loudon Surgical Home 
February 23, 1961 

History.— Although married several years, has had no children. 
About a year ago I uttered from pain in the right side, which, however, 
being treated was cured. In April last the pain returned in the 
backj and at short intervals has recurred. At times the pain 
severe that she is unable to walk. Has fur thirteen years suffered 1 
from Leooonfccea, globus hystericus, &c. ; and has always had dis- 
taste for marital intercourse. 



23 

Examination confirming ine in the diagnosis I had formed of 
this case, I, on February 28, operated in the usual manner Her 
viy was retarded by an attack of jaundice, but in May she 
was discharged cured, 

In July, 1862, this patient was seen quite well and ruddy , and 
bad long lost all her old symptoms, She had been once pregnant, 
ut miscarried at three months. 

In July, 1865, she came to town with her youngest child. She 
was quite well, and had never been ill since the Operation, 

Remarks. — This was the first case of this nature under my care, 
in which the patient, formerly sterile, became pregnant after re- 
moval of the cause of her illness. 



Case IV. Hysteria, with Sleeplessness — Six Yeaes 1 
Illness — Operation — Cuke. 

H. R., set 55, single ; admitted iuto the London Surgical Home 
Nov. 18, 1861. 

/.—For six years has suffered from a feeling of fulness, 
weight, and beat at the lower part of abdomen, with pain in tho back, 
and " bearing down." At this time her menses had just ceased. 
Has not slept well for three or four years. Wakes every hour. Is 
always restless and fidgety. Frequent desire to micturate, with 
pain on doing so, and often desire without power to void it. Bowels 
costive ; digestion indiflerent. 

She is a nervous, restless woman, with glistening and constantly 
wandering eye— pupils dilated, Has suffered from peripheral irri- 
tation for many years. 

Nov. 21, 1861. Usual operation performed. A week later, slept 
well for four hours, the first time for many years. 

Dec. 1. Has lost the irritability of the bladder, and passes water 
every four hours only ; lost also the bearing-down pain j restless 
excitement gone. 

Dec, 7. Eats and sleeps well ; is cheerful and grateful ; leaves 
the Home cured, having been in only three weeks. 

In IWS was perfectly well. 



I 



24 



Case V. Fissure of the Rectum, with Hystebu— 
Operation for the former — Relief — Subsequent 
Operation for Hysteria — Cure. 

Mrs. L., set, 55 ; admitted into the London Surgical Home Dec 9 t 
1861. 

History* — Is a widow. Has for many years suffered from all the 
inconveniences of a fissure of the rectum, combined with bad 
digestion, undue nervous excitability, and sleepless night 
very anxious to be cured. It being thought that all these symp- 
toms might be due to a painful fissure of the rectum, the ordinary 
operation for this affection was performed on December 12. The 
bowels were opened in a few days without pain, and the fissure ww 
healing well. Being, however, still sleepless, excitable, and iri i 
questions were asked which showed that a further operation for 
removal of another source of irritation was advisable ; therefore, cm 
December 24, 1 performed my usual operation. The next night she 
slept welL She became quiet and cheerful, and on January 6> 
1362, she was discharged quite weU. 

Remarks*^ This case is very interesting, as it shows that there 
may exist at the same time more than one irritation exerting inhibi- 
tory influence. 



Case VI. Hysteria, with Epileptiform Attacks 
in Childhood — Various Ailments for Thirteen 
Years — Operation — No Benefit. 

H. D,. tot, 23 single ; admitted into the Loudon Surgical Home 
April, 1862. 

History, — When very young, until ten years of age, had frequent 
fits. Improved in health till she was fourteen years of age, when 
she began to suffer from abdominal enlargement. First menstru- 
ated at nineteen. Is constantly sick after meals. Has been in 



25 



nearly every hospital in London. The patient is very hysterical, 
I is always talking religion. 

On examination the abdomen was found very tympanitic. Under 
chloroform this state quite subsided. Walls of abdomen fat and 
muscular. Body generally well nourished. Evidence of continual 
irritation of the pudic nerve. 

April 3. Operation as usual 

For some time after the operation this patient was much better 
of the sickness, and great interest was manifested by several 
visitors in her case; she never, however, received permanent 
benefit, being a regular impostor, and discovered on several occasions 
handkerchiefs, &c, tightly round her waist to make her 
abdomen swell She was discharged as incurable. 

He-marks. — This case I have inserted as a warning. It is no fault 
of the operation if it fail in such < 



Case VII. Hysteeia — Several Yeaks j Illness — 
Operation — Cure, 

Miss M., set. 42 ; admitted into the London Surgical Home April 
13, 1862. 

History. — Has felt ailing for many years, but fur the lust two 
•has Buffered pain in the uterine region, and, on pre Bf the 

ovaries. This pain is accompanied by bearing down, and a sense 
of distension. Suffers from considerable leuconhtea. Menstrua- 
tion regular, and during the period the pain is absent. Bowels 
regular. Sleep disturbed. Feels depressed, and is inclined to 
melancholia. 

On examination there was no congestion of uterus or enlarge- 
ment of ovaries, but there was evidence of peripheral irritation of 
the pudic nerve. 

April 17. Usual operation performed. 

She rapidly improved j sleep and cheerfulness retunu'd, and all 

in left her. She expressed herself as not having been so well 
many years. 




May 13. Left the Home, having gained flesh and streng 
and being quite cured of all her bad symptoms, 

McTmrks. — Interest attaches to this case, as instead of exaceih 
tion, there was diminution of the symptoms during menstmatioa 



Case VIII. Hysteria — Many Years' III 
Phantom Tumour — Operation — Cure. 

A. B., set. 24 ; admitted into the London Surgical Home 16th 
July, 1862. 

History, — Is a single woman, and procures a living by dre»* 
making. When younger, was a nurse-maid. Catanienia comix* < 
before she was thirteen, but she was not regular until she was 
nineteen, since which the function has proceeded normally both in 
time and quantity, Has for many years been ailing, and alwayB 
had something the matter. Has suffered from intense irritation in 
the genital region, especially in the bladder, and she has coi 
pain in the back. For two years has been treated at a dispensary 
for an abdominal tumour ; during this period she has takuu much 
medicine, but without benefit. 

On £j ami nation the abdomen was found increased in size and 
universally tympanitic. Under the influence of chloroform the 
swelling entirely subsided. 

July 17. Usual operation performed under the influence of 
chloroform, 

Sept. 2. She was discharged quite cured, all her hysterical 
symptoms having left her, and the tumour never having been seen 
since the day of operatiom 

Case IX. Hysteria — Five Years' Illness — Sterility 
— Operation — Cuke — Pregnancy — Two Childeen. 

Mrs. 0. came under my care in 1S62. She had been ill ever 
since marriage, five years previously ; having distaste for the 
society of her husband, always laid upon the sofa, and under 






medical treatment. Evidence of peripheral excitement being 
manifest, I perforin ed my usual operation. She rapidly lost all 
the hysterical symptoms which had previously existed ; and in 
about a year came up to town to consult me concerning a tumour, 
which greatly frightened her, as she feared it was ovarian, I dis- 
covered that she w T as six mouths preprint. She was delivered at 
full time of a healthy child- In 1665 she again called on me to 
show herself, not only in robust health, but pregnant for the 
second tu 



Cai 



se X. Hysteria — Irritation or Eight Ovary — 
Menorrhagia — Nine Years 5 Illness — Operation — 
Cuki:. 



c 

C. M. A., »t 28, single ; admitted into the London Surgical 
Home Juno 22, 18G3. 

lory. — Since the age of 19 has been more or less subject to 
ttteriae flooding; for the first three years lost blood everyday* 
Eaa been five times in a metropolitan hospital ; always better 
while there, but as bad as ever as soon as she left. The bleeding 
ich worse at each menstrual period. She passes large coagula; 
has constant pain in the back, headache, and palpitation of the 
heart, and canuot sleep j is dreadfully pale and anaemic. 

ttHon showed great irritation over right ovary, and there 
was evidence of long-continued peripheral irritation. 

July 2. Usual operation. 

July 7. Menstruation came on in a moderate flow. 

July 10, Menstruation ceased; is much better, and there is 
sign of returning colour in the faee, 

July 31. Has improved considerably, and had no return of 
the bleeding. To be discharged cured. 




28 



Case XI. Hysteria — Many Years' Illness — Or 
tion — Cure — Marriage and Progeny. 



Emma K., at. 22, single ; admitted September 16, 1S63, in 
the London Surgical Home. 

History. — Commenced menstruating at 15 years of age, 
owing to the use of cold water during a period, the secretion 
arrested for six months ; the function was then restored, and has 
ever since continued normal At 16 she suffered from piles, which 
occasioned very much irritation and pain after each evacuation. 
aggravated by constipation and by walking. Though regular as 
to time, there is always excessive catamenial flow, and it lasts for 
eight days. Has been under long and varied medical treatment, 
without benefit 

Examination, showed peripheral irritation, as evinced by the 
abnormal condition of the external genitals. 

Sept. 17, 1863. The usual operation performed, 

Oct. 1. Progressing most favourably. 

Oct 22. Leaves quite cured. 

1866. This lady married, and was delivered August, 1865, of 
a living child. She is still quite welL 






It will have been observed that one very prominent 
symptom in many of the foregoing cases is sleepless- 
ness, or perhaps more properly, freqnent wakefulness 
at nights, and constant restless movements in the 
day, These are the cases which, if left to go on, 
are very liable to terminate in insanity. The three 
following are instances in which the hysteria was 
verging on this state, and as they can hardly be 
classed nnder the head of insanity, I prefer 
rating them here. 



Case XII. Hybteeia — Mental Aberration, and 
Tendency to Melancholia — Eight Yeaes* Illness 
— Operation — Cuke. 

In December, 1861, a single lady consulted me, giving the fol- 
lowing history of her illness : — 

Has not been well for seven or eight years ; has felt languid, and 
not so lively as formerly. For the last two years has menstruated 
every three weeks, and the flow bun lasted four or five days. There 
is considerable white discharge from the vagina after each period, 
lasting for a week. Great irritation about vulva, perinamm, and 
anus before :md during each menstrual period. For the last five 
or six years had had occasional irresistible and unaccountable fits 
of depression ; thinks that it is her mind — if her mind were as 
strong as her body she would be pretty well : her memory is good, 
but mind weak. Has suffered from great pain at lower part of the 
back ; says she cannot rise from a chair without great difficulty, 
on account of a feeling of stiffness in hips and trembling of the 
leg* (this is probably owing to a swelling of the hip-joint, as all 
the joints of her fingers and ankles are swollen). Says she can sit 
quietly to crochet or needlework, but cannot sit quietly to think, 
or compose her mind to write a letter : has not written a letter 
properly for three years. Has been subject to attacks of melan- 
choly and weeping, without any tangible cause, but which she 
cannot resist. Suffers from want of sleep, and at night frequently 
lies awake four or five hours together. Appetite good ; bowels 
costive. 

In appearance is fresh-coloured and plump, but she says she is 
thinner than formerly ; dark eyes j large dilated pupils. 

(hi examination there was evidence of great irritation about the 
vulva, and constriction of the anus, with a very small fi&smto, 

Dec. 21. I divided the fissure, and performed my usual 
ttion. 

Dec 31. Yery much improved ; swelling of the joints much 
less. 




30 

Jan. 1- She sat up, and feels much better. Her spirits are 
improved ; baa no pain in the joints ; sleeps welL In soother 
month she returned home quite well, and has continued so to the 
present time. 



Case XHL Extreme Hysteria, verging ok 

— Five Years' Illness — Operation — Cure. 

>Irs. , a?t. 32, married • admitted into the London Su 

Home August 5, 1862. 

History.— Has been married twelve years, but has had no children 
nor miscarriages. Has always enjoyed pretty good health until 
about five years ago, when she began to suffer from leucorthcea 
and great pain during menstruation. Catanienia regular in time 
and quantity. Her bladder is so irritable that sometimes she has 
to pass her water every half-hour ; the urine sometimes very much 
loaded. Suffers from headache and giddiness in the morning, 
that for the last three years the act of coition has been 
plished without the least pleasure, but with pain. Bowels are 
opened regularly and without pain. 

August 7. Having diagnosed the cause of the disease, 
usual operation was performed. 

August 9. A severe attack of erysipelas came on, and she 
was very ill for some days, but she made a good recovery. 

A few days after the operation this patient was observed to 1 
occasionally very violent and unmanageable, and to have it the 
times a wild maniacal look* On questioning her husband, it 
appeared that for several years she had been subject to fits of vioh 
excitement, especially during the menstrual period, and that at sue 
times ■ she would fly at him and rend his skin, like a tigress/ 

This patient made a good recovery ; she remained quite well, i 
became in every respect a good wife. 



■y much 
91 

accom- 

are 

she 

J, it 
such 



Case Xl\ . Extreme Hysteeia — Incipient Insanity — 
Operation — Cure. 

Mrs. K., set 42 ; admitted into the London Surgical Home Aug. 5, 



History. — Has been married, but has been a widow for twelve 
Is companion to a lady. Never had any family. Has been 
ailing for some years, but has not suffered severely until the last 
eix months. Suffers most from pain in the lower part of the abdo- 
men, and from constant burning and irritation about the vulva. 
During the last few months has become very nervous and fidgety ; 
never can remain quiet, and says that lately she M has had a sort of 
lost feeling, particularly when writing ; being unable to compose her 
thoughts, or concentrate her mental energies/ Has suffered from 
considerable irritability of the bladder ; and her urine is often 
full of thick deposit. Catamenia regular in time and quantity. 
Cannot sleep. 

On examination, is a very nervous woman, her eyes restless and 
never quiet ; constant Switchings of the limbs, and occasionally an 
appearance almost of insanity about her expression. There is every 
evidence of a long-continued inhibitory influence. 

August 7, The usual operation performed. 

August 8. Feels very comfortable. Slept better last night 
than for some years. 

August 9. Is improving wonderfully : the expression of coun- 
tenance completely changt-il. 

Sept. 9. Left quite well. Has got fat, and has now a cheer- 
ful face and manner. Says she feels a different bemg, and is quite 
astonished at her own improvement Has lost all her nervous 
twitchings and other uncomfortable symptoms, and has now a com- 
fortable night's rest. 



32 



CHAPTER IV, 

SPINAL IRRITATION, WITH CASKS. 

THERE are perhaps few terms so difficult to define 
as spinal irritation, for the gradations from 
hysteria to this state are extremely easy ; and, indeed, 
it will have been seen that in the foregoing chapter 
most of the patients complained of pain in the spine, 
and that there was more or less functional disturbance 
in all of them. The term is also used so freely and 
vaguely that great caution is necessary in attempting 
to explain its meaning. Dr. Handfield Jones's term, 
" Spinal Paresis/' seems to me an excellent one; by it 
he means " a state in which, without demonstrable 
organic change, there is greater or less enfeeblement 
of the functional power " of the spinal cord. The 
sensory or motor power may be affected, but rarely 
both together. 

The cause of spinal irritation, or paresis, may be 
defined in one word — " debility ; " this debility always, 
or almost always, being due to inhibitory irritation. 

This state of things may give rise to wide and varied 
disorders, all the symptoms of which are asthenic in 



character, and all of which are marked by 
treme nervous prostration, 
fithout doubt, — for all authors agree on this point, 
of the most prominent causes is peripheral irrita- 
of the pudic nerve, producing undue exhaustion, 
i is difficult to say how this is produced, but most 
3 ably it is that, " owing to the intimate commissural 
Elections between the lumbar enlargement of the 
d, where the pudic nerves are implanted (they them- 
ves being small and remote in their origin from the 
1) \ and the superior and nobler nervous centres, 
intense excitation of even a small and remote 
tre is communicated to the others, which, as this 
ides, fall as much below, as they have previously 
l stimulated above par. The depression is pro- 
rtional to the previous excitement," 
lie cases I shall have to relate which may fairly be 
led cases of spinal irritation are few in number, for 
reason I have stated, that they are but a continna- 
l of hysteria,* and, indeed, but a state of things of 
ich epileptiform and epileptic fits are the direct 
uence, 

t is, however, well to draw attention to the fact 

t it is in cases of spinal irritation that we observe 

fractional derangements, which are very likely to pass 

actual organic diseases ; and it is in this class of 

ases, which are essentially of a chronic character, 

# Vide Oases in previous chapter. 



M 

fa*y Md persistant yumT&mw* wash] 
4M, Mbn, whrbe all who m 
\mt tmitmln ^ ^■*^* i^ that ih*'V rourt 
nuuUbt»rfce J if recorwy do ©ot c»fne 1 

b * W«i tor. 

hmiTAttox, aki> surrosso Unifli] 

.***■**! te«»» yottttg lmdr t jrfc 20, of wW 
v v t Hif*ibi? lindbe^ceannelto 1 
*u »•**•» iBptyuied to suffer from ittw**n>* 
lhW app&mttis, attached to ^^ 
•i§ ^mtthim ami pubfcs and intended tt fe 
W «Usro* in poftitaoa. fMbafi 
.ad alitor tfampeutk ng^nts for nl 
Viv HW4**» uwc«i»i in position and healthy rc 
,>iti»iiiHjj and exanunatiuQ, Idi* 
1 i !■ H| i Uh> pudk aervfc Mj opinion *a* 

s luwit thai th* yooag taly was very ^ 



. iiw** *** to be attributed soklj & 
Loral i I *** 



ni «wi MA nil a*c«B4nly immo 

■* **t* i* tfc» <ra« of marmge, ml 

„ utAtmq h ttg g il iw* and prevents 

j t \ .„ .,, >&> gteafcy ^*»* objections *** 

i ,,, u , k ■ k iiut uuv.ac to .uiduce actual cases in con 






'|. \, |M 






m a ui\ ^K\<uu>u in the usual manner. Fc 

u vui tJtw isufc oi the uutse* the dressing* 1 

u> , i i.wi, -wvcuhciva^s at the end of amonth th 

;».'U <M U u> vuuK uhivv uuie*. 



35 



Case XYI, Dysmenorrhea — Five Years' Illness — 
Operation — Cure. 

D. A., set, 23 ; admitted into the London Surgical Home Aug. 4, 

63. 

History. — Has never been very strong ; but five years ago had 

i attack of gastric fever. Since then ha* suffered constantly from 
at pain during the menstrual period. Occasionally loses a great 
deal, and passes large clots of blood During this time has suffered 
almost constantly from leucorrhcBa, Soften severely from pain over 
region of left ovary and in the spine. Is hardly ever free from 
headaches. Is very restless ; never sleeps well ; frequently faints ; 
and has little or no appetite, All her ills are exaggerated at the 

K~-5tmal epoch, 
ugust 7. Usual operation performed. 
>pt. L Ts nin «st mating without pain. 
Bept 30. Again menstruating without pain, and in normal 
Dtity. Is to be discharged cured. 



se XVII. Spinal Irritation and Loss of Use of 
Right Leg — Fite Years' Illness — Operation- 
Cube. 

M, B. ? ret. 30, single ; admitted into the London Surgical Home 
i:», 1861. 

|f, — Five years ago first began to suffer pain in tin 
*, which was ascribed to sciatica. Fourteen mouths since this 
pain became so bad that she could not walk, and she lost all use of 
igbt leg, at the same time felt great weakness and pain in the 
buck, preventing her sitting. For eight months has been confined 
to a "spinal couch. ,T Is a spare anaemic woman; dark hair and 
eyes ; dilated pupils ; very restless and nervous in her movements, 
and of a very irritable temper. Has suffered from peripheral irrita- 
tion since an early age. 

D 2 



37 



XTX t Menorrhagia — Mental Delusion — Two 
ibs j Illness — Operation — Cuke — Subsequent 
uriage and progeny. 

■ly, set. 20, came under my care in 1863, having for 
ars past suffered from almost constant menorrhagia, during 
time she had suffered great irritability of temper, been dis- 
it to her mothers wishes, and had sleepless nights, restless 
for society, and was constantly seeking admiration ; all these 
mis culminating in a monomania that every gentleman she 
id was in love with her, and she insisted on always sending 
ie dt vuite to her favoured one for the time being. Id her 
| moments she would spend much time in serious reading, 
iug consulted, I quickly discovered that all these symptoms 
rom peripheral excitement, and that there existed no organic 
* to cause fche menorrhagia. The usual plan # of treatment 
llowed with the most rapid and marked success. She went 
1 interval between the ensuing menstrual periods, and the 
on was normal in quantity. All her delusions disappeared, 
ter three or four months of careful watching, with change of 
5 was perfectly well in every respect. A year afterwards she 
il, and ten months later gave birth to a healthy son. She is 
;ain pregnant. 

XX, Spinal Irritation, giving risb to Menoe 

RHAGIA AND AMAUROSIS — OPERATION* — CtJRE, 

iglelady, a?t. 35, came under my care in 1863. Had been out 
th for some yearn, suffering from continuous menorrhagia, 

being free more than ten days or a fortnight in the month, 
lin and spare in appearance ; often complaining of headache, 
lly over the brow and orbits ; and, in fact, nearly a con- 

invalid* Latterly she had become almost blind from 
»sis ; she could only read the largest type, and not at all by 






39 



bruise. Her countenance had a worn and haggard expres- 
her body was emaciated ; skin harsh, dry, and scary ; (tie 
wev extremities hung us if paralyzed, but sensibility and voluntary 
r, very weak — were not entirely aba 
complained of severe spasmodic attacks of agonudng pain 
hooting up the spine, like tetanic shocks. Her appetite was 
defective, digestion was impaired, the bowels disordered, and sleep 
i was hardly ever procured. There was also partial ptosis of the left 
upper eyelid. On examination, I found a deep and acutely painful 
fissure, with large piles and loose skin around the anus, and all 
the well-marked signs of peripheral irritation of the clitoris. 

August, 1863, I operated, Dr. Kidd administering rldoro- 
fonn. I divided the fissure, tied the piles with three ligatures, cut 
oft' the loose skin around the anus, and removed the clitoris and 
elongated Libia in my usual manner. 

It was gratifying to observe the early relief of her more severe 
aptoms ; by the third day the spasmodic attacks ceased, little 
tio pain was complained of, and the improvement if the digestive 
l was most marked, the patient enjoying chops, game, &l\, 
ten days, and no longer **a martyr to flatulence and 
dyspepsia," The digestion was, however, easily deranged, and 
at care was necessary. At the end of seven weeks, having 
dy on several occasions been driven out in a carriage, she was 
uoved to the country, where she remained for three weeks. It 
way be here stated that the patient suffered much from the very 
■ttltry weather of September, and that improvement was much 
more rapid when colder weather set in, On her ret urn, she was 
able to stand for a few minutes with her hands resting on the 
shoulders of another. Remaining in town for some weeks, sue 
tun left for the sea-side, where she stayed about three weeks, 
ad returned to town in the beginning of this year. Her condition 
ia now as follows : — 

She looks remarkably well in the face, which has entirely lost its 

expression of Buffering. She is free from pain. Sensibility in the 

ower extremities is perfect ; their muscular power is greatly im- 

ved. She can raise herself from a chair so as to rest on bar 



40 

hands and feet, and is able to walk across her room, holding the 
hands of her maid, who retreats before her. She sleeps well every 
night, and her digestion is in very fair order. She is now able to 
sit up to all her meals, and to sit in an upright chair for bonis 
together, whereas formerly she -was constantly in the recumbent 
position. 



43 



Oam XXII. Nine Tears' Illness — Epileptiform 
Attacks — Three Years' Duration — Operation — 

ClJBB. 

G. M., single ; admitted into the London Surgical Home Decem- 
ber 18, 1860. 

History. — For the last nine years has suffered greatly and regu- 
larly during the menstrual periods. Has been much worse for the 
last three years, during which time has, at each menstrual period, 
been frequently taken in a fit, dropping down suddenly and fainting 
right off ; this state lasting for two or three hours. Being in service, 
this has caused her much trouble, as none of her employers would 
keep her. For the last six months has suffered severe pain over 
right ovary, increased by exercise or pressure, and at the menstrual 
period. Believing that the dysmenorrhea and fits both arose from 
the same cause, on January 3, clitoris was cut down to the base. 
After this operation she never had a fit, and all untoward symptoms 
left her except the dysmenorrhea ; she was therefore re-admitted 
May 27, 1861, and there being some narrowing of the cervix, it was 
incised with the hysterotome. June 21, catamenia came on with- 
out pain, and continued to do so regularly. In July she was well 
enough to return to service. 

April, 1865. Her mother called at my house to say that this 
patient had been married some months, and was shortly expecting 
her confinement She had remained quite well since the operation. 



Case XX 111. Epileptoid Fits — Fifteen Years — 
■ Illness for Twenty-six Years — Operation — Cure. 

F. A. C, at 41, single ; admitted into the London Surgical 
Home Not. 6, 1863. 

Hutory. — Says she had congestion of the brain fifteen years ago ; 
since that period cannot remember being well, but from the age of 



u 



fifteen has been of delicate health. Has suffered from fits for the 
last fourteen or fifteen years j is never long free from them. During 
an attack she is not entirely unconscious, but possesses no power to 
Control them nor to speak. Hub pain at lower part of spine of A 
gnawing character. She is a miserable, nervous creature, 
pinched features and^a wandering restless expression of the eye. 
There is evidence of injurious peripheral irritation since a very 
early age. 

Nov. 12. Operation as usual under chloroform. 

Nov. 1 9. Is wonderfully better. The expression of her face is 
much happier, and the face itself has filled out considerably. No 
pain in the back since the operation. 

Dec 24, Discharged perfectly cured. 



Case XXIV. Hysterical Epilepsy — Long Duration 
— Operation — Cure. 

G. 0., set. 25 ; admitted into the London Surgical Home Jan. 
1864. 

History— Has been delicate from childhood. For some months 
has suffered from a peculiar dragging pain in the lower part of the 
abdomen. Menstruates regularly. Suiters from "burning" and 
irritability of bladder. Has constant and severe headache 
for a long time suffered from " epileptic fits" (on careful otwefl 
tion they were found not to he genuine epileptic), occurring 
or thrice a week. Is a melancholy object, with " woe-begone ' ex 
preasion ; listless and indifferent to conversation and surrounding 
objects j wheu spoken to, does not answer rationally, and frequently 
only in monosyllables. Is very reserved and taciturn. 

Feb. 4. Patient being under chloroform, the clitoris wasexci 

Feb. 13. Progressing favourably ; much improved in ap] 
ance ; more cheerful ; con verses freely and rationally ; expressi 
herself as grateful for her restoration to h 

March 1, Haying had no return of the fits, and lost alt her 
hysterical symptoms, she was discharged cured. 



9 and 

serva- 
twice 

iding 
ently 

need 

>pear- 
rocpoo 




45 



XXV\ Hysteria and Epileptiform Attacks 
— Many Years* Illness — Operation — Cure. 

E, D., set 31 ; admitted into the London Surgical Home Feb, 17, 



History. — Married eight years, with one child. Her husband is 

i the navy, and often absent from home. Previous to her marriage 

, a severe illness, in whicb she was delirious, and again in 1860, 

. she lost her reason for six weeks. " Was very feverish and 

retain no food on the stomach." The menstrual periods are 

I irregular, six or eight mouths sometimes elapsing between 

menstruated since June last. Ha? 

ilty in passing her urine. For many years has suffered from 

an epileptiform character, having, in an attack, convulsions 

rigidity, but never hurting herself in falling, foaming at the 

oath, nor biting her tongue. 

Feb. 18. Clitoris ex 

Feb. 24. Much improved, free from pain or difficulty in mic 
ritiom Is quite cheerful, and has had no attack since the operation. 
26. Still gaining strength, looks much better, and aay 
she now feels well. 

March 28. Discharged cured. 

Case 5 



Jase XXVI. Epileptiform Fits and General Hys- 
teria — Four Years 1 Duration — Operation — Cure. 



Mrs. F., set. 44 ; admitted into the London Surgical Home April 
23, 1664. 

History— Married sixteen years, but her husband has been 

abroad for the past seven years. Had innammation of the womb 

four years ago, and since that time has continually suffered from 

bearing-doNvn pains. Frequent desire to micturate. Pain in the 

Dins and spine, sleepless nights, loss of appetite, and other hysterical 






46 

symptoms. Has slight " epileptic fits " two or three times a week, 
more frequently at catamenial periods, which are regular in appear- 
ance and not profuse. Has no premonition of fits ; is but partially 
conscious ; at first struggles, then becomes rather rigid, and on re- 
covery is always exhausted. Patient is most anxious to be cured 
of her attacks, of the cause of which she is fully conscious. 

April 25. Clitoris excised, under chloroform. 

April 26. Had a good night, better than for years. 

April 30. Progressing most favourably. Patient expresses great 
gratitude for the relief she has obtained. She left the Home a 
month later, looking and feeling quite well ; the last note in the 
case-book being "a very grateful patient." 



Case XXVII. Epileptiform Fits — Six Years' 
Duration — Operation — Cure. 

F. W., set. 33, single ; admitted into the London Surgical Home 
May 23, 1864. 

History. — Has suffered from fits for more than six years, mucl* 
more frequently the last six months ; having now as man^ 
as four or five during the day —always one or two. The fits vary it^ 
length from one to three hours' duration. Is conscious during the^ 
attacks, but unable to speak, or in any way to control them. Is^ 
invariably worse during the menstrual periods. Suffers from palpi- 
tation of the heart. 

Examination showed a highly inflamed and sensitive condition of 
the external generative organs ; the patient herself confirmed my 
opinion of the cause of her attacks. 

May 28. Clitoris excised — free haemorrhage allowed before the 
dressings were applied. 

June 12. Left her bed to-day ; has had no fit since the operation, 
and says she feels well. 

June 20. Takes daily exercise, is free from pain, the wound is 
healed, and her health daily improving. Action of the heart much 
more moderate. 



47 

July 19. Discharged cured, not having had one hysterical attack 
since the operation. 



Case XXVIII. Hysterical Epilepsy — Three Years 
and a Half Duration — Operation — Cure. 

C. E. S., set 24, single ; admitted into the London Surgical 
Home Oct. 17, 1864. 

History. — Has been ill for about three years and a half, suffering 
frequently from an aggravated form of hysterical attacks, with 
many of the characters of epilepsy, but with only partial insensi- 
bility, and without foaming. Is often sick, and suffers from severe 
pain on the right side, with a feeling of pressure on the lower 
bowel, with a dragging and bearing-down pain around the loins. 
Catamenia regular ; more subject to the fits at these periods. No 
difficulty in micturition, but a rather frequent desire to micturate ; 
and urine often loaded. 

Oct. 20. The clitoris was excised. 

This patient improved very rapidly ; passed upwards of a month 
and a menstrual period in the Home without any return of the fits. 
All pain over the ovarian regions, and in the loins, &c., left her, and 
she was discharged Nov. 26, perfectly cured. 




11 i' m in L^tremcly rare, and I tmak 
Hiy**rli JuvunnHl in having witnessed throe wdl* 

l j "■ fl It, ooom chiefly," saya Dp. Jmm, 

Iftfttl whn Imvo weakly nntf excitable ncnroni 
lb*!"". IbftMi btllth, aud ill-governed minds, sad 
trim m*J Im mild to poorness neither a 'menssana/ 
t»" I 'tMUPJMII wamtiii.'" That this is true therein 
m"I i\w lu&Mt dottbij ami the first case— one of semi* 
h^mI^I^Y, 0* h^itorioal catalepsy — shows how com- 
| f |i,h ly It lw ii rmrvuim uftuction, and depending, at 
fUtA Ai( tilt cMnuiimnoomont of the disease, very 
, 1(1>l |) mh innoinl oontroli 

Tlt^M '<»» nifty ii. in tnu% ono or two rare cases on 
, Pk ,,,Ml tfilfnll tttiW puttied by growths on the brain; 
mmI II. In N>nn't.imt'H ** encountered in tubercular 
ffl#ffto|fitf#j W dbrOttlfl softening of the brain/ 1 — 
Hpyntilil*, 

Th&fc the Gaum* in tho three cases in my own 
wm0t'M wiMi excitation of the pudic nerve, may, I 



^ 



49 

ink, mosfc fairly be concluded, from the fact that 

r the operation neither patient had a single fit. 
To those who have not seen a patient suffering from 
s disease, a few words from Dr. Reynolds ma 
^cessary :■ — 
u The pathognomonic symptom is the persistence 
the limbs in a state of balanced muscular OOlttrac- 
ro, so that they retain the position in which they 
re placed at the commencement of tlio attack. The 
ibs may bo readily moved by the observer, but 
iy retain the attitudes in which they are left, and 
?se sometimes for hours, sometimes for days, 
u Perception and volition are lost ; the condition 
iembles that of 'brown study; 1 the circulation mil 
spi ration are uninterrupted." 

Catalepsy seems to rank between tetanus and 
pay, and, according to Dr. Jones, depends on the 
simultaneous morbid affection of various nerve cent 
Aiiich, when separately affected, produce but one dis- 
dcr, — hysteria, tetanus, or epilepsy. 



3ase XXIX. Hysterical Catalepsy— Many Tears 1 
Duration — Operation — Relief— Remarks. 

Mrs. v set, 33, widow ; admitted into the London Sm_ 

Bome Mayo, 1865. 

History.— Never bad any children, and but one miscarriage. 

taxation began when she was fourteen, and she was then first 

stacked with fits. From the patient's description, they would 

have then been of a cataleptic character ; there WftB Ao 

B 



50 

loss of consciousness. From the age of 21 up to the present time, 
besides slight convulsive attacks in the daytime, she has been 
subject to fits at night, occurring irregularly, but averaging one 
a week, and always after each menstrual period. They commence 
with a strong convulsion, which lasts for a few minutes, and is 
succeeded by perfect rigidity of the body and unconsciousness for 
half an hour or more. Are preceded by headache during the day. 
Catamenia appear regularly, but are scanty. Acknowledges 
constant peripheral excitation, and says that, during marriage, she 
never had pleasure in coitu. The dilated pupil, hot skin, moist 
palm, and other unmistakable symptoms, plainly pointed to the 
cause of her disorder. 

May 6. Excision of clitoris and the very elongated nymphae. 
Free haemorrhage was allowed before the wound was dressed. 

The operation was, in this instance, only successful in diminish- 
ing the frequency and intensity of the fits. The following is the 
description given by the house-surgeon of an attack some days 
after the operation : — 

" While conversing with the house-surgeon this morning, she had 
a slight convulsive attack, not lasting more than thirty seconds, 
and characterized by the following phenomena : — No loss of con- 
sciousness, rigidity of limbs, with tonic contraction of the flexor 
muscles, and strong contraction of the orbicularis palpebrarum." 

Whenever visited, and frequently when the wound was dressed, 
these fits recurred ; but towards the end of the month the number 
considerably diminished. 

She was discharged on June 15th, very much improved in healthy 
and decidedly relieved by the operation. 

Case XXX. Hysterical Cataleptic Fits op Longs 
Duration — Operation — Cure. 

H. L., aet. 25, single ; admitted into the London Surgical Homes 
January 27, 1864. 

History. — This patient was sent to me by Dr. Pennefather, oM 
Tottenham, with the following letter : — 



"Dear Sir, — The 'girl was some time since suffering from 

religious monomania ; she is of hysterical habit and weak constitu- 
tion, ever complaining of abdominal pain or uneasiness." 

She also gave the following additional account of herself : — 

" Began to feel unwell about twelve months since. Had a very 
bad fever about five months ago, which left her perfectly prostrated. 
Always felt weak, and more or less subject to fits. Menstruation 
regular .and never profuse. Great pain in the back and bearing- 
down feeling in the lower part of the body. Complains of great 
pain in defecation. Sea-bathing has benefitted her temporarily. Is 
incessantly crying without cause or power to prevent herself." 

The day following admission she had a fit of a cataleptic nature, 
and lasting twenty-five minutes. After the fit the patient was left 
very prostrated. 

In addition to symptoms of pudic irritation, there was a small 
fissure of the rectum. 

January 24. Clitoris excised, and fissure divided. There was 
considerable secondary haemorrhage in the excising, which, however, 
seemed to have a beneficial effect, as after it the patient expressed 
herself as more comfortable, and slept quietly. 

Feb. 14. Much more cheerful ; has had no cataleptic attack or 
symptom of hysteria since the operation. 

Feb. 28. Has improved daily, and kaves the Home this day 
cured. 



Case XXXI, Cataleptic Fits — Two Years' Illness 
— Operation — Cure. 

M. N., aet. 17 ; admitted into the London Surgical Home Sep- 
tember 4, 1861. 

History. — Was perfectly well up to the age of fifteen, when 
^Xie went to a boarding-school in the West of England. In the 
bourse of three or four months she became subject to all symptoms 
^>f hysteria, and from that time gradually got worse, having fits, at 
*irst mild in character and of rare occurrence, but gradually mere 
Severe and frequent, till she became a confirmed cataleptic For 

E 2 



m 



several months before admission, she had been attack 
many M four or five tits B day, and daring the whole journey I 
the North of England to London she was unconscious ;r 
cataleptic. She was seen immediately on arrival, and there i 
no doubt that it was a genuine case of thia disease. So flensiti 
-lie, that if any one merely touched her bed, OX Walked N 
the room, she would immediately be thrown into the cat&kp 
state. 

Before making any personal examination, Mr, Brown uacer 
both from her mother and herself, that she had long indulged i 
telf-excltation of the clitoris, having first been taught by a bcImx 
fellow. The commencement of ber illness corresponded ex 
with the origin of its cause; in fact, cause and effect were! 
so perfectly manifested, that it hardly wanted anything more t 
the history to enable one to form a correct diagnosis. All iln it! 
symptom* attending these cases were, however, well marked. 

The next day after admission she was operated upon, and foe 
that date she never hud a fit. She remained in the Home for 
several weeks. Five weeks after operation, she walked at] ov- 
Westminster Abbey, whereas for quite a year and a half befot 
treatment, she had been incapable of the slightest exertion* 



XXXII. Cataleptic Fits — Many Years 1 Dura- 
tion — Operation — Cure. 



In 1861 I saw a lady, at. r»0, single — a patient of Dr. Da^ 
of Neweastle-on J 

She had been Buffering from cataleptic attacks for several yei 
gradually increasing in severity. As in the previous case, the i 
touching or shaking of her bed would induce an attack in 
the simple brushing of her dress by any one passing her when 

viilked out of doors, would immediately be follow. 
Hiaiory and examination plainly confirming me in my opinion as 
to the cause of her attacks, the usual treatment was ado] 
and from that time to this she has never had an attack. 



53 



kSE XXXIII. Cataleptic Fits — Six Yeaks* Dura- 
tion — Operation — Cure. 

Miss , mt 38, single ; admitted into the London Bui 

Rome August 10, i 

HitiUtry. — Was tolerably well until two years and a half ago, 
Ifaiit since that time has Buffered more or lav from menon 1 

re pain in back, Has also severe smarting pain to the 
bowels, and has frequently lost a considerable quantity of blood 
X>er anum. Has always been subject to hysterical attacks, but 
I lie last six years has had fits of a much more serious cha- 
racter. They have increased in severity, duration, and frequency, 
and it is on account of them that she seeks relief. Almost imme- 
diately after admission, this patient had a fit, and she was kept a 
fortnight under observation, that the nature of the attacks might 
V>e thoroughly Investigated. 

She would have a fit sometimes twice a day ; but on an ave 
*a,bout every other day — either early in the morning or late in the 
evening. She was most generally attacked when walking about 
the room — sometimes when sitting — but she was never observed 
to have one when asleep. She would at the commencement of mi 
k cease walking, or doing whatever she was employed in ; her 
face would become very pale aud set; the eyelids, at first quivering, 
would be fixed ; the eyes wide open and looking upwards, the 
pupils very dilated. Her mouth would be rigidly shut, and during 
the attack it was impossible by any means to open it Her arms 
would fall straight by her side, and be immovable ; the hands 
unclenched, and fingers extended* If standing, she would be quite 
upright, and require uo support. If sitting, she would always 
1 up when a fit was coming on. If lying, she would be ex- 
tended straight on her back. The fit would last for two or three 
hours, and on a few occasions for as many as six hours. The experi- 
ment was frequently made of moving her arms when in the cataleptic 
state, and on such occasions the limb would remain in the position 



54 

in which it was placed, till the end of the attack. She was always 
perfectly unconscious, and no kind of stimulant was of the slightest 
use in restoring her during the paroxysm — time alone was of avail. 
The attack was sudden, but the recovery to consciousness was but 
gradual ; she would appear as if awoke from a deep sleep, and 
would be very exhausted, but express no desire for food, wine, or 
other stimulants. As soon as she recovered, she would sleep for 
many hours, and awake quite well, but still weak. 

Aug. 24. The clitoris was excised, and a painful fissure of 
the rectum divided. She never had a fit after the operation. 
Menstruation came on on the 28th, in moderate flow. 

Oct. 5. This patient has improved wonderfully since operation, 
and now looks extremely well. The wound is quite healed. She 
takes walks daily, and has had no fits, and is to be discharged 
as cured. 

In November she called at the Home, to say that she was quite 
well, and had never had the slightest return of her former illness ; 
she menstruates regularly and normally. 

Feb., 1866. She remains welL 



00 



CHAPTER VII. 

EPILEPSY, WITH CASES. 

REFERRING my readers for full information on the 
pathology and history of epilepsy to Dr. Russell 
Reynolds's exhaustive treatise on the subject already 
referred to, I would mention, as shortly as possible, a 
few facts which are necessary to be borne in mind, with 
especial reference to the class of cases which I am now 
considering. 

Dr. J. C. Prichard, in writing of diseases of the 
nervous system, has well said that " few diseases are 
better characterized by their symptoms than epilepsy ; 
yet in this instance there is such a variety in the phe- 
nomena as renders it difficult to contrive a definition in 
a few words which may comprehend every form of the 
complaint." 

I have said that when convulsions become chronic 
they are considered to take on an epileptiform cha- 
racter. Now, although we know that in a few cases 
involuntary spasm may take place in sleep, i.e. with 
loss of consciousness, I think we may, for all general 
purposes, take as a definition of epilepsy a chronic 



56 

convulsive disease, each convulsive attack being 
accompanied with "sudden and complete loss of 
consciousness/' this latter symptom being considered 
by the late Dr. Todd* as " the pathognomonic symp- 
tom of the disease/* but only, as Dr. Reynolds t has 
shown, " when it occurs as a paroxysmal or occasional 
event." 

The causes of epilepsy are various — " partly physical, 
partly immaterial." Of the former are injuries and 
tumours of the brain or meninges, intestinal worms, 
renal and biliary calculi, &c. &c. These are termed 
by Dr. Handfield Jones J " eccentric causes." As 
" centric causes," he names " poisoning of the blood 
from retention of excrementitious matter; this, by 
deranging the nutrition of the nervous tissue, gene- 
rates the abnormal excitability, which then manifests 
itself without any special irritant. Various causes of 
exhaustion, such a£ haemorrhage and excessive dis- 
charges, venereal excesses, prolonged want of sleep, 
unremitting pain," &c, are all " centric " causes of 
epilepsy. 

Dr. Reynolds is right in considering epilepsy an 
idiopathic disease, inasmuch as it occurs, without dis- 
coverable organic lesion with which it can be associated, 
and because there is no structural lesion of the brain, or 
spinal cord, to be found constantly associated with it ; 

* Medical Times and Gazette, August 5, 1854, p. 129. 
t Op. tit, p. 31. t Op. c&, p. 209. 






when lie Bays that it is idiopathic because, " io many 
sgj eccentric irritation cannot be shown to be the 
cause of the attacks/ 1 1 cannot go with bini. Epilespy is 
a name signifying a disease , which may be idiopathic, or 
may arise from a variety of causes ; but that eccentric 
irritation is a powerful and very frequent cause, there 
is not the slightest doubt. Di\ Reynolds classes it as 
second of six in a table given in his book, physical 
conditions being mentioned as first ; and finding, in a 
hundred cases, that 24*68 have no assignable cause, 
and 18"8i are doubtful, bo gives 13*04 aa due to 

f centric irritation. 
In considering peripheral irritation of the pudic 
nerve as a cause of this disease, we must, I think, con- 
sider mental emotion, which occupies the highest rank 
in causes of epilepsy, in conjunction with that second 
in the list,— eccentric irritation. I would, therefore, 
classify the cause of epilepsy depending on such irri- 
tation as both eccentric and centric. The former, 
inasmuch as it produces exhaustion, and, by deranging 
the nutrition of the nervous tissue, generates abnor- 
mal excitability ■ the latter, for that it is a physical ex- 
citant which is not only (i a mere provocative of the 
paroxysms, the convulsions being supposed to ensue 
as the reflex results of irritation, but that it actually 
wfo vp in the nervous centres that state of excitability 
which is the essence of the disorder." Further still, 
looking on epilepsy as a direct sequel of hysteria, 
when it is produced by excitation of the pudic nerve, 




58 

the patients are, in an eminent degree, predisposed to 
the disease. 

Women are also more naturally prone to epilepsy 
from mental emotion than men ; " Emotional disturb- 
ance being assigned/' says Dr. Eeynolds, "as the 
cause of their attacks in so many as 36 per cent., 
whereas in the male sex there were only 13 per cent, 
who referred their diseases to that cause ." 

It would be out of place in a work of this nature to 
detail at length the symptoms of these attacks- 
Whether they are truly epileptic will be seen as th^ 
cases are related. I have been very careful to separate 
those which seemed to be of an hysterical or epileptoiA- 
nature ; and have had the advantage of being able tor* 
show the greater number of them to many eminent 
members of the medical profession, who have witnessed^ 
my practice in the London Surgical Home. 



Case XXXIV. Epileptic Fits — Twelve Years* 
Duration — Operation — Cure. 

S. F., set. 41, single ; admitted into the London Surgical Home 
Dec. 16, 1861. 

History. — Was always ailing, and hysterical for many years. 
Catamenia appeared early, and always rather profuse. For the last 
twelve years has suffered from epileptic fits ; recurring frequently 
every week or fortnight, and lately as often as every day. Has 
constant headaches ; is losing memory and all power of concen- 
trating her ideas. Has no premonition of seizure ; falls down ; is 
unconscious ; has frequently bitten her tongue ; and " froths " at 



the month, i ha* had several attacks of hannateniesk Bhe 

i dressiual .1 bo frequently,, on her way to oc from 

"business, fallen in the streets, tli.it she hail been carried into almost 
ry hospital in London, and a large number of open surgeries. 

sre was found every mdic&tiofi of irritation 
about the vulva, and also a small pulypiiH of the os uteri, which 
latter was Large and patulous, 

Dec. 19. Usual operation of excision ; polypus uteri also r« 

■moved. 
The recovery of this patient was rapid and uninterrupted After 
the Operation, she never hud a fit, and hardly a headache. She was 
discharged .Tun. 20, L862, perfectly well, and with greatly increased 
mental power. When heard of at commencement of 1864, she 

I remained wtlh and had had no recurrence of any of her old 
symptoms. 

Case XXXV. Epileptic Fits — Five Years' Dura- 
tion — Peecedjed by Cataleptic Fits, during the 
Ten previous Years— Opekation — Cure. 

In the beginning of April, 1862, a single lady, wt. 28, came 
under my notice, giving the following account of herself. — When 
about ten years old had a fit, whilst she was sitting ai needlework ; 
she fell down suddenly as if dead, and remained insensible for two 
hours ; was very ill for three weeks after the attack. Was quite 
well until the age of fourteen, when she began to have them 
every three months. When about twenty-two had an interval of 

» eleven months without a fit, but frequently fainted during that 
period During the time she was in the fits she would be perfectly 
unconscious, She was told that her limbs were quite rigid, and 

P always remained in the exact position in which they were when the 
fit commenced. In 1857 the fitl changed is their nature — the patient 
at first r dint j down quietly, but subsequently becoming very con- 
vulsed, and trying to hurt herself. The first of this nature lasted two 
hours and three-quarters. Has lately hurl them much oftener, but 
not always of the severe form. Has had eight severe fits iu the 



60 



last two years and a half, besides the milder, which co 
sometimes a dozen in a fortnight, Is unconscious, but alway 
knows when she has had one. Foams at the mouth t but rnalv 
noise. Has frequently fallen down suddenly in church and other 
public places. Has been under many physicians, ail of whom hay© 
been of opinion that she is suffering from genuine epilepsy. 

April ± Clitoris excised. 

April 6. Has had no attack, but complains of occasional pain 
\\,f tup ,it' \wr head. 

1 an attack after the operation. Returned home in a 
month t and shortly afterwards she Was thrown out of a pony chaise ; 
she had no fit, but wrote that, prior to treatment, i very mu 
slighter accident would have immediately produced one. 

I heard of this lady later in the year ; she was still quite 
Not having heard since from her, as was agreed when die left 1 
I am satisfied that she has had no relapse. 



Case XXXVI. Epileptic Fits — Many Years' Due 
tion — Operation — C I 



N. Li &£*, at, 8] ; admitted into the London Surgical Home 
Maya, IS6& 

History.' — Married four years and had two children ; the labours 
have hern had, and followed by severe hemorrhage. Had ab 
:ii six \\t\ iks, a fortnight previous to admission, and had lost a large 
>|n iKtity of blood. First suffered from epileptic fits at puberty ; 
had several before marriage, and has had four or five since marriag 
but has never had a fit when pregnant. Not very regular in me 
gtru&tion, winch is accompanied with severe pain. Has const 
gwffl OB right side Of bead, in hark, loins, &C Great ] iii in in niictu 
rating iiij.l « »rj cl ■! IsGAtidfL She is always totally unconscious during 
f li. lits, arid they are followed by extreme prostration. Is of men 
eh o 1 1 i ve ly a mern ic, and so m e wb at ehl oro tic j eve 

the mucous membranes (of mouth especially) are blanched. 



61 



of her fits being diagnosed, the usual oration was performed 

ay 14. 

May 18, Pro^j ellently. 

May 20. There was great irritability of the Madder, which, 
however, was immediately relieved by an alkaline and henbfltt 
mixti 

May 31. Has not hud any return of her had symptom* until 
to-day, when, on beinu: removed to a strange waul, she had a fit, 
£ violent character, and followed bj a beary irowau 

June 2, Is quite herself again. 

July 4. Has left quite well in every respect, and when heard 
of many months later remained welL 

Remarks. — The fit following on change of this patient Irin OZW 
ward to another where there were strangers, shows how iuipo- 
it Lb for a permanent cure, that visitors and relatives should not be 
allowed to excite and agitate a patient suffering from these attacks 
:ui operation is performed, and when the mind is hardly 
restored to its natural balance. 



E XXXVIL Epileptic Fits — Two Years' Dura- 
tion — Operation — Cure* 

H. C, fct, 20, single ; admitted into the London Surgical Home 
Feb. 24 ? 1 

History. — About three years since, first commenced ailing. 

Menstruation ceased for four months, when it appeared for two 

days, Fifteen months then elapsed before the function was centered 

otic tits Lave been developed for about two year*, The patient 

it the commencement of an attack is strongly convulsed, has no 

premonition, and is perfectly unconscious, Frequently falls when 

walking in the streets. Has often hurt herself in lur falls, ami abo 

her tongue. Has the usual symptoms of bearing-down of 

the womb, and pain in the loins. No pain in defecation. Bowels 

e. Pain in micturition, and sometimes retention of urine. 

; illy not passing any for two days. 



62 

March 3. Clitoris excised in the usual manner under chloro- 
form. Was restless and hysterical for the first six days, when she 
improved daily, became cheerful, and much more intelligent. She 
never had another fit, and on April 13, being quite cured, was, at her 
own request, retained in the Home as a servant. She remained 
there under observation for six months, during which time she had 
not only no return of her former attacks, but progressively im- 
proved in health, and her menstruation became quite regular. 

Since that time she has been living as cook in a family which 
I frequently visit, and it is therefore certain that she remains 
perfectly well. 



Case XXXVIII. Severe and Frequent Epileptic Fits 
for Three Years and a Half — Operation — Cure. 

C. T., set. 21 ; admitted into the London Surgical Home June 
23, 1864. 

History. — Health always good till three years ago, when, after a 
severe fright, she became very excited and had a fit. Since that 
time has been continually subject to them. She never passes a day 
without two or three, and frequently has as many as six, or even 
eight, in the twenty-four hours. Is most subject to them at night 
when sleeping. Is always suffering from headache. Her mental 
powers are somewhat impaired, as she has very slight recollection 
of persons, or of events, from day to day. Catamenia very irregular. 
Has not menstruated since March last. Bowels costive ; pulse 
regular .and firm. Is of a sallow complexion, with vacant and weak 
expression of countenance. Acknowledges great and constant irri- 
tation of pudic nerve. 

During the day previous to operation, special notice was taken 
of the nature of the fits. They are epileptic ; for although she does 
not foam at the mouth, she has, on more than one occasion, bitten 
her tongue, and is perfectly unconscious. There is no rigidity, but 
a constant struggling, and, unless restrained, the hands always, 
during an attack, are carried to the seat of irritation. 



63 

June 23. The usual operation of excision was performed under 
I chloroform. As soon as she recovered, she managed to remove the 
dressings. Haemorrhage for two hours was the result. When 
arrested, two grains of opium were administered, which produced 
sleep. On awaking, she again endeavoured to remove the dressings ; 
but, her han ds being confined, she was unable to do so. She had 
no more fits, and but a few hysterical attacks. On July 17th she 
was discharged, as her parents were anxious for her return. She 
had not then had a fit of any kind for sixteen days. 

August 15. I received the following letter from her father : — 

" Dear Sir, — It would be very unkind in me, and much out of 
place, to hide from you and the world at large what have been my 
feelings during the past three weeks. My daughter, C. T., came to 
your Home, Stanley Terrace, Notting Hill, on the 23rd of June 
last, to be treated by you for epilepsy, or epileptic fits, having been 
afflicted for three years and a half. The class of fit you may better 
judge of than myself ; sufficient to say, they were very bad 
and very frequent. I am happy to say, and acquaint you, that 
since her return she has not had a single symptom of fit or hysteria 
of any kind. Her general health is also very good, and fast im- 
proving, and I do hope, by the blessing of God, she may continue 
so. If you have any desire to see her, I shall feel in duty bound 
to let her wait upon you, with her mother, at any time you may 
think fit to appoint, as your opinion just at this time might have a 
still more happy effect for the future. You are quite at liberty to 
use this for the benefit of the Institution in whatever way you may 
like or seem good." 

A twelvemonth later, this patient was still free from any return 
of the fits. 



64 



Case XXXIX. Epilepsy, with Dementia — One Year's 
Duration — Operation — Cure. 

A. H., set. 17 ; admitted into the London Surgical Home June 
28, 1864. 

History. — Catamenia first appeared three years ago. They have 
continued regular to the present, time. About twelve months since 
was observed, whenever sent on an errand from home, that she 
would wander about in an absent manner, and return home having 
forgotten all about any message which had been given her. About 
this time fits were first developed ; they increased in frequency 
and intensity, and she now has them daily, and one or more of less 
violent character nearly every night in her sleep. When seized, 
she falls, struggles violently, foams at the mouth, often bites her 
tongue, and is totally unconscious to all around her. After a fit, 
she sinks into a deep sleep, which lasts for two hours. Has no 
recollection on awaking of what has taken place. Acknowledges 
to frequent injurious habits, but is unconscious of their being the 
cause of her illness. Is vague in all her ideas and conversation, 
and has almost entirely lost her memory. 

Both history and personal examination plainly showed what was 
the cause of her attacks. 

On July 7 the clitoris was completely excised. She had no 
return of the fits ; and on the 23rd the following report appears in 
the case-book : — " Left her bed to-day. Is greatly changed ; quite 
rational in all her movements ; converses freely and quietly, re- 
members passing events from day to day, and it is indeed almost 
impossible to recognize in her the half-idiotic, almost demented 
girl who entered the Home less than a month ago." 

She remained in the Home some time longer for observation. 
Fits never returned ; her mind improved daily, and she was dis- 
charged as perfectly cured. 



Case XL. Epileptic Fits — Two Years and a Half 
Duration — Operation — Relief. 

S. Z., set. 16, single ; admitted into the London Surgical Home 
October 20, 1865. 

History. — Was strong and well until two and a half years ago, 
'when she had an epileptic fit in the middle of the night. Can 
assign no cause for the attack. For a long time had a fit once a 
month, but latterly once a week. The catamenia appeared six 
months before the first fit, and have always been regular. There 
is no exacerbation at menstrual epoch. Complains of great irrita- 
tion of pudendals for three years. 

Nov. 2. Since admission this patient has been watched : she 
has had two fits, both of a genuine epileptic character. 

Mr. Brown this day performed his usual operation. She went 
on well till the 10th, when she had a slight fit ; there being irre- 
sistible irritation, the hands were restrained. A lotion of bromide 
of ammonium was ordered to be applied to the wound, and 20 
grains of the bromide to be given in water three times daily. 

She convalesced well, and had no more attacks till the 29th, when, 
her hands having been released only a few minutes previously, she 
had a fit, and the nurse found one hand on the wound. She was 
conscious during the attack, which was not so violent as before. 
treatment. 

Dec. 2. Discharged relieved If this patient could be under 
control for a few months, she would probably be cured. 



Case XLI. Epileptic Fits, with Dementia — Thirty 
Years'' Duration — Operation — Cure. 

M. R, aet. 44, single ; admitted into the London Surgical Home 
December 8, 1865. 

History. — Epileptic fits first attacked her when she was about 

F 



66 

14, at which age she menstruated. For the first few years there 
was a long interval between each, but they gradually became more 
frequent and violent. Latterly she has had several during the 
week of each menstrual period, and as a role none in the interval 
Catamenia have been tolerably regular in appearance, but rather 
profuse. Is tall, pale, and thin ; has a dull and somewhat vacant 
expression ; is very eccentric in her manners and conversation ; is 
frequently observed, both day and night, by the nurses to practise 
injurious habits, to which she acknowledges for the last thirty 
years. The fits are genuine epileptic. 

On examination, there is evidence of very long-continued peri- 
pheral irritation, and also a fissure of rectum. 

Dec. 12. The usual operation on clitoris and rectum. 

Dec. 13. In the absence of nurse, removed the dressing, and 
immediately had a fit To have opium 1 grain, with £ grain of 
extract of belladonna, every six hours. 

Under this treatment the patient improved daily, became cheer- 
ful, rational, tractable, and much more sensible in her conversation. 

She passed two menstrual epochs, but without a fit, and she was 
discharged perfectly cured. 

I have a much larger number of cases occurring 
in private practice, but, for that reason, am obliged 
to omit them. I shall, however, when a longer time 
has elapsed, publish them. 



67 



CHAPTEE VIII. 

IDIOTCY AND INSANITY, WITH CASES. 

AS EPILEPSY is a much graver disease than 
hysteria, so is the sequel of the former — 
dementia or idiotcy — much more permanent and diffi- 
cult to be removed by treatment than insanity, which 
is the ordinary sequel of hysteria. 

I shall give but one case of idiotcy, because I 
regret to say that I have never yet been able to 
thoroughly restore the mental powers in any patients 
suffering from this dreadful affliction. Epilepsy is 
such a chronic disease, and seems to me to produce 
not only weakening of the mind, but to cause it to be 
often entirely lost, that, although we may get, as in 
the following case, a temporary re-kindling of the 
mental energies, I fear we are not yet able to give 
much hope of complete recovery. Even here, how- 
ever, I have such faith in the efficacy of perseverance 
in constant watching, that I am almost inclined to 
believe that, had this patient been in a condition of 
life to ensure vigilant medical supervision for a 
lengthened period after operation, we might at last 

f2 



LANE UB*^.*W^ 



68 

have succeeded in, if not complete, at least, much 
greater restoration than in a public institution, or to 
those in humble circumstances, the surgeon is in a 
condition to promise. 

Case XLIL Epileptic Fits, with Complete Idiotoy 
— Operation — Great Temporary Relief, but not 
Permanent Benefit. 

Mary J., set. 19, single ; admitted into the London Surgical 
Home Feb. 15, 1864. 

This patient was brought to me by Dr. Marley, with the follow- 
ing account : — 

" Has the appearance of a child of 10 or 12 years old ; mammae 
not developed ; has had epileptic fits ever since 12 years of age. 
Is now almost idiotic ; stares vacantly ; slobbers at the mouth ; 
passes her motions anywhere, without regard to common decency, 
and cannot retain her urine. L find from her mother that she 
is incessantly irritating her genitals. Her fits vary in frequency, 
from two or three a day to four or five a week. Being satisfied of 
the cause of her fits, I sent her to you." 

History, taken at the Home from her mother. — Had perfect 
health until she reached her eleventh year ; was forward in her 
lessons, and well educated for her age and position. At this time 
she was suddenly seized with a severe fit, for which no cause could 
be assigned. A period of two years elapsed before she had a 
second, when, being placed under medical treatment for eighteen 
months, she had great relief. Since the expiration of that time to 
the present she has constantly suffered from fits. 

Her intellect did not begin to weaken until two years since, but 
she ceased growing and learning" after the first attack. At this 
time she does not know her right hand from her left ; does not 
know her mother, and shows no signs whatever of ordinary intelli- 
gence. From being cleanly as a child, is now most filthy— in fact, 
is in every sense an idiot. 




**ever menstruated* 

rinariora— although, as stated by Dr. Marley, the niaiunuv 
^"fcry rudimentary— there was full development, and indeed 
,^* T tttal hypertrophy, of the external genitals. 
v iK ^K 18. The usual operation performed, under chloroform. The 

**s to be restrained* and the patient most carefully watched* • 
* fcb. 19* Has passed a good night, and is quirt. 
™*b, 23. Has been very drowsy since the operation* To-day 
f^ked for food for the first time, and showed some signs of intel- 
*^<*nce. 

Feb. 2H. Gave rational answers to several questions which were 
***ked her. Also remembers from day to day any promises of 
delicacies of diet or money. 

March L Passed a good night ; feels free from pain. Was 
given some printed cards, which she read — the jird time for r&m 
fears. 

March 2. Improving much. Is much more modest in her be- 
haviour, but still passes her excretions without regard to time or 
place. Notices passing events, and remembers names anil faces. 

March 3* Has given sensible and somewhat witty replies to 
various questions asked her in the presence of about twenty medical 
gentlemen, who to-day came to see the operation. When moneys 
were given her, she at once told their different relative value. 

March 4. Morning : Seems no w r orse for the excitement of 
yesterday. — Evening : Had a slight fit 

March 5. A little heavy and stupid to-day. Somewhat irritable 
and obstinate* 

March £J. Much better. Has a daily clearer notion of right 
and wrong. Likes hooks with pictures and large print. When 
she comes to hard words, she asks the meaning, like a child, but 
cannot always grasp the meaning of an explanation. 

March 8. Not quite so well to-day. Had a slight epileptic fit 
tJiis evening, followed by a very severe one in two hours. 
March !>* Again much better, but irritable. 
March 1 2* Two fits. 
March 1G. Not so well : another fit to-day. 




70 

She from this time seemed to retrograde ; and on the 4th of 
April was discharged as incurable. 

It will be recollected how, at the end of the chapter 
on Hysteria, I gave three cases of extreme nervous 
irritability, with sleeplessness, and tendency to an 
unhinging of the mental equilibrium. We now come 
to insanity itself. It would be vain to talk of the 
varieties of forms in which this state may be seen, 
when produced by abnormal peripheral irritation of 
the pudic nerve. It is, however, worthy of notice 
how each history seems to tell its own explanation of 
the cause ; and after the first few days of treatment, 
when excitement, caused by irritation from the wound 
and a natural repugnance to restraint, has passed off, 
how rapid is the improvement, and how permanent is 
the result. I have no hesitation in saying that in no 
case am I so certain of a permanent cure as in acute 
nympho-mania ; for I have never after my treatment 
seen a recurrence of the disease, whereas, under 
medical treatment, of how short duration is but too 
frequently the benefit. 

Case XLIII. Incipient Suicidal Mania — Many Years' 
Gradual Illness — Operation — Cure. 

E. T., set. 39, single ; admitted into the London Surgical Home 
Oct. 22, 1861. 

History. — Has been ailing for many years, and given great 
trouble and anxiety to her friends. For some time past she has 



71 

been very strange in her manner, very restless, never quiet, con- 
stantly wakeful, threatening suicide, talking to people, even perfect 
of her ailments and their causes, of which she is fully 
clous, Was formerly modest and quiet. 

ton, ahe is ■ Int woman, of restless appearance and 
manner : eye warulerinju; and unsteady ; pupil dilated* Th> 
mental derangement being obvious, on 
Oct. L r 4 the usual operation was performed. 
The improvement in her i n en t id and bodily health was v underfill ! 
she gained flesh, and became cheerful and modest, Sh6TO8difr 
charged six weeks after admission. 

When heard of in FebriiNiy, 1663, this patient continued quilt 
welL 

The first case of actual insanity that came under 
my tare w.ts a patient of Dr. Warren Diamond, then 
resident in his private asylum. I canuot do better 
than transcribe the account which lie sent me with 
the following note : — 



u Effra Hall, Brixton, S, 

" Dear Sir, — A month having elapsed since you gave up your 
patient, I forward some particulars of the case, and shall be glad to 
answer more Fully any special time or state you would like to know 
more about You will, perhaps, be able to pick something out of 
this rambling account that may be interesting to you. Hoping fan 
will excuse oniissiom. 

" Believe me, yours faithfully, 
" W LfiRBfl H. 1'! I 
"I. Baker Brown, Esq." 



72 



Case XLIV. Sever s — Two Mo 

VNTTY — OrilKATlON— 

nation, living with ba 

i dish-brown ; face set and vacant, with on occ:t> 
fixed and dull 
attire moderate and well formed. Has for several ; 
rtked on by her friends as dhHVivnt from others—strange 
centric. Would go out and walk away into the country ola 
for miles, and come back exhausted When friends called, would 

Pup and run round the garden, or to the top of the house i 
n£uin f giving no reason for it hut that she must do it 
tingiT irritable and passionate. Unless some i 
on, was listless and unable to r -. When at parti< 

o forward and open in her manners, that the was 
mi by gentlemen. Never h<ul an off* 

I mot her died about a year and a half ago, 
the occurrence, and was consequently remarked on )\ hex In 
has been getting mon- strange and peculiar, About 
sister told her, in joke, thai if she did 
care she would soon become a fit subject for Dr. Diamond, litt 
thinking how soon it would happen. 
uds, so that her brothers could not make oul \\\\y \ 
Ml oft Would *it or stand without noticing them when th 
called ; and asked them what they wanted that they came to 1 
of the family). 
M I Ited about her in the end of March, but had then 

sYiouB history. She was vacant and dream; 
b ahe called her friends ; said 'people's faces were 
nuuk* ; that she was quite unable to rouse or employ herself, as 
1 ; T very uncertain in appetite, going a day without 
ig at night, and for the ha wing 

-h . ! passion, that her sistea wew r^pured 



73 



"I recommended change along the south coast, with Ittl -1 Milling, 
&a She did not improve ; and the attendant infix of a 

QOnstant irritation of fcbe vulva, lotions were used, but without 
benefit. Her general health and appetite improved ; but not the 
mind. She could not sleep, and would not bear nareoti 
lants acted as narcotic*, but soon Inst their effect. 

" Bowels regular \ puke small and slow ; action of heart being 
irritable, and not corresponding at all times to the power or quan- 
tity of the puke. She sits up in bed, DUnSag the pillow, and 
talking to it as if it were a baby ; says * that a he died last Sunday ' 
— * is lost ' — * is buried. 1 

" When out of doors, great difficulty is experienced in getting her 
i in ; she wishes to wander away, without aim or purpose. 
Having given my opinion to her friends, I was authorised to admit 
her April 13, 1861. Before she left home, she continued calling 
out, * Take me to a mad-house ! take me quick, or I shall never get 
well ! * She persisted in saying * she was dead,' and ' she felt 
i* A n- were iu monosyllables. Her pupil is contracted and 
fixed. At. night she does not sleep, and is in such a continual state 
of excitement thai the attendant cannot sleep with her, Has lost 
all natural modesty iu manner and speech. Is not blasphemous. 
Before me is perfectly reserved and correct in her manner. When 
I ask quest ions, she will, after a pause, answer in monosyllables, or 
repeat the question over and over again, as if trying to grasp the 
meaning and ally her thoughts. Unless walked about, will stand 
for hours in one place, gaping, yawning, and throwing her arms 
about listlessly. She was in this state when you saw her, and from 
uliif yon told me of your experience of the operation and its 
results, I was led to infer relief from it in this case, as the delu- 
f having died on a certain day was movable and could be 
bat the heavy oppressed feeling still made her say, 
'But if 1 am not dead, I am lost, or changed,' and naturally led 
back to the idea. I ascribed the state of her mind to weakening of 
the body, and general nervous irritation caused by long-continued 
reflex excitation j and I believed that if the source of irritation could 
be removed, her mental health would follow as her blood became 
healthy, and fit to make reparation. 






74 



s 

fcion 



u I was led to think more of tier uterine state from her expn 
of pain when she wan walked about, and she was reported by 
nurse as always complaining of hex tack, at the lower part, and of 
great tenderness on pressure over die ovaries. 

"May i!7, 1861. You operated on her, she being under the in 
fluence of chloroform. She waa naturally restless afterwards, no 
understanding why she was kept is bed. Profuse mei 

on in the evening, which bad not happened for four mo] 
previously, and then always vex; ad with ranch pain. Half 

an OUHOe of laudanum, with oil, was rubbed into b 
four hours ; she did not, however, sleep, but continued moaning all 
night. 

"May 28. Easier, and more herself— takes her food, 
w May -K Slept well lost ni^ht, without opiates ; hall 

now get well and be able to go home ; answers questions more 
readily, and m akes lo nger replies. Fwpil di la ted 
Her nurse says she is quite altered in every way, and compares the 
change in her mind since the operation to * dividing the tightened 
strings of a tiddh?, and letting them all loose.' 

" June 2. Left her bed ; is still in- kg ; appears clieerful ; 

asks questions now, and oonveiM s for short periods ; has done a 
faff stitches of needlework ; says nothing about * being lost 
dead* since the operation. Surface of body and extremi 
In ; iky, anxious look about her eyes and nose gone. Id 
jokes. Says ' she has been in a dream,' i that thing* i 
light, 7 and ' that she means to get well' 

li July 3. She has gradually improved and become more natural 
in her habits and ideas \ sleeps soundly every night ; takes her 
meals well ; walks about without compulsion ; takes a pride in 
making herself neat, and has washed and dressed herself ever sine 
she left her bed ; is perfectly modest iu manner and conversation 
Her friends remark on the great improvement in her muni, .di 
having had no delusions. Her mental state is, however, k 
what might better be called foolish, with some amount of 
obstinacy. Tbe family medical attendant, and, in fact, every on 
who 1ms been in her company, notice the extraordinary chang 



me a 

st or 

B and 

-seem 



that has taken place in her since your operation, I think 
present state of hei mind results from the long-continued exhaus- 
tion, and to restore it will be a matter of tuna Her pupil> ,n i 
illy/' 
I have often since heard of this lady as perfectly well, and as 
never having had recurrence of illness. In I860 I was con 
on the propriety of marriage, to which I gave my full consent 



Case XLY, Acute Insanity — Two Months — Opera 
tion — Cuee. 

Miss — , set, 17, moderate height, and well formed, hair light 
golden, grey eyes and fair complexion, canic under my care June 
19, 18*U. 

History (taken from her mother). — When ten years old^ had in- 
flammation m1 tin \voinli t and after she recovered began to men- 
struate. The function continued regularly until about eight months 
ago, since when the eatamenia have appeared every ten days, and, 
in fact, have been hardly ever absent. In the latter part of last 
April she left home for change of air, and returned May 15th, 
when her moth I that she was thinner than before her 

departure, and, on Inquiry, it appeared that during the latter prnrt 
of her stay she had been very excited, at other times very low, 
sometimes laughing and singing, and requiring port wine and 
brandy at all t imes of the day, though generally abstemious, and 
never taking wine or other stimuli. The first night after her return 
went to one of her sisters' rooms and begun to talk of being 
ed ; did not ileep all that night May 17th. Was found to 
•e rather wild in the morning ; was taken out for a drive during 
the day ; did not sleep that night, from const ant excitement of the 
genitals. Had been seen by her ordinary medical attendant, who 
ordered opiuti s, but without the effect uf giving her sleep. On the 
mother physician saw her, and ordered opiates, but without 
effect, as she did not have an hour's sleep night or day. May 22nd. 
An eminent authority in female diseases was called in, and also, 



I 







76 



among other remedies, ordered opiates at night-time, bat with 
effect. She continued raving and rambling till June 8th, when it 
physician, who devotes himself to mental disease*, saw her; he 
said thai her mind was not affected, hut that her behaviour was 
caused simply by debility, and ordered wine, eggs, &c, and a strong 
but without the desired effect. 

June 17. Was much worse. The last physician again saw her ; 
said that she was quite mad, must be taken from home, and 
never recover. She called her mother " Monsieur le Diable," and 
her father M God," She was constantly irritating her clitoris, and 
indulged in most immodest behaviour. Was ordered ext. cannabis 
indicse, and slept three hours. 19th. No better, and on this day I 
first saw her ; she wou then wild in expression of countenance, and 
on entering the room she addressed me as "Your Majesty," and said 
u I was the Queen." . She also asked, *' Why has your Majesty con- 
descended to visit me ? " 

June 21. Before operating! the patient being under chloroform, 
I made an exam i nation, and found my diagnosis verified by the 
existence of all the ordinary local symptoms. The hymen was quite 
absent. (In one of her paroxysms she had stuffed a pocket hand- 
kerchief into the vagina.) I performed my usual operation, and imme- 
diately administered two grains of opium. She passed a 
night, not being noisy, but not sleeping. 

June 22. Tolerably quiet. Not aware of what is passing around 
her, but apparently comfortable. To have broth and milk diet — no 
stimulants. 

June 23. Passed a qniet night ; but did not sleep much, though 
she had a grain of opium. Dressing removed. Wound looking 
well. 

June 24 Has not passed quite such n good night — rather noisy, 

June 25. Menses came on. Has had a very bad night, and 
been very troublesome, Chloroform administered to insensibility 
several times in the course of the day. A liniment, eontaini] 
seven drachms of soap liniment and one drachm of laudanum, 
be rubbed in to thy chest constantly. This seemed to quiet her. 

June 27. Has passed a rather better night, sleeping a little ; 



ne- 



77 

towards morning she became very noisy, and chloroform was again 
admio] !Y< have the liniment nibbed in at night. 

June 28. A much better night 

June 29. Has had a very fear night ; and from this time she 
graduaEy improved, sleeping well and being generally quite rati 
her appetite also improved. 

July 7. Menstruation occurred, and she was not ho well for a 
day or two, as she attempted to irritate the wound ; hut, being 
carefully watched, was prevented. 

July 10, Catamenia ceased. Is quiet again. 

July 11. Went out in a bath chair, and said she enjoyed the 
airing. From this time she gradually got better, and on the 2Hth 
she went into the country ibr change. Her menses came on five 
weeks from the last appearance ; she was quite quiet all the time. 
Since then she has menstruated regularly every three weeks, and 
in normal quantity. 

A year after operation she had a alight relapse of melancholy, 
and fears irew entertained that she was again going to be ill ; but a 
brisk purgation of calomel completely dispersed all symptoms. 

1866. 1 have frequently heard of this young lady. She IB now 
in good health, moving in high society, and universally admired. 



Case XL VI. Hysterical Homicidal Mania — One 
Year's Duration — Operation — Cure. 

In December, 1861, Mrs. came under my care, by the re- 
commendation of Dr. Forbes Winslow. She gave me the following 
history of herself : — 

History. — She was 57, and had had four children and two pre- 
niiiiiir labours. The bat child was born twenty- three years ago. 
Twenty months since had an attack of erysipelas in the face, with 
eruptions on different parts of the body. Has never been will 
since, and last August had another attack of erysipelas. Is cuu- 
stantly suffering with abivcrmgs, followed by burning heat ami 
sweating, with prickling heat of the skin. For the last year has 



giUUiiii., 



78 



never slept for more than an hour ; always waking a\ 

feeling frantic, and very hot and flushed* II ant feeling 

that she will be lost eternally, and uf thL* she is constantly 

speak 

From her husband I learnt the following : — 

After her last confinement, twenty-three years ago, she 
puerperal mania, from which lbs did not completely recover 
six months. About a year ago she began to show symptoms 
mental derangement, first exhibited in religious subjects, she 
stantly declaring that her soul was irrevocably lost. About e 
months ago she first tried to destroy herself, by endeavouring to 
jump out of the window, &c, and it was at this time thought ad- 
visable to place In r in an asylum, where she was kept four m 
and when she left she was for a time much better. While 
inmate of the asylum, was made to take much exercise, for which 
her husband says she is always better. 

She gradually got worse, and came under the care of Dr. For' 
Winslow, to whom I am indebted for the case. Her hosb; 
says that for the last two or three months she has slept pretty w< 
from 10 p.m. till 2 a,ra., when she would suddenly wake, and Wi 
hi in that a " frenzy" was coming on. This frenzy consisted in her 
rising up, fighting out with her arms, and scratching 
one near her ; in the paroxysm the desire was always to destn 
her husband. After a few minutes the mania would subside, and 
be succeeded, first by a kind of stupor, and then very profuse 
perspirations. One peculiarity about her is, that when in this 
state she does or says anything foolish, she knows it, and is 
wards very annoyed and ashamed of her conduct. She has a 
fear that she will be permanently mad. 

The appetite has always been good, though she has said late 
that she cannot bear food, and that it always causes a horrid ta- 
in her mouth. She has, in a desultory manner, read many medic 
works, and fancies that every one of her organs is in some way 
other 

foo&m, she had the appearance of a woman about 
IU -v eyes, of a dark grey, were never quiet, and could not look yoi 



ad- 
an 



her 

nay 
troy 



79 



Straight in the face ; the pupil was much and constantly dilated. 
Hie tongue quite clean, and polae good. Heart* lungs, and other 
organs seemed to be healthy. She owned with great shame to 
long-continued pernicious habits. 

Dec* 14. I performed my usual operation. 

Dec. 21. Has very much improved, and had no " frenzies " 
since the opemtion ; sleeps well) and for many hours, but will not 
own to being better. Complains of her skin being dry, and 
" burning hot." It is, however, moist and cool ; at times she 
perspires freely, 

Dec. 26. Both husband and nurse consider her much unproved. 
She has been up both yesterday and to-day ; Bleeps and eats well. 
She is, however, sulky ; says she is very bad, and shall soon die. 

A fortnight III - i she was quite well, being entirely free since the 
operation from maniacal attacks ; but she complained to my son, 
Mr. Boyer Brown, that 1 had unsexed her. He answered that 
nothing of the sort had been done, but that tJxfl operation had 
prevented her from making herself ill- From this time she steadily 
improved, and walked out wilh her husband every day, who called 
on me many weeks later to express his gratitude for the complete 
restoration of his wife to health ; for whereas before his nights 
were passed in constant fear, rendering his life most wretched, his 
home was now one of comfort and happiness both night and day. 



Case XLVII. Acute Hysterical Mania — Four 
Months' D ueation — Operation — C u re . 



Miss , set. 23, was sent to me by Mr. Bttdcliffe, stating 

en brought over from Ire I insane patient, 

and that everything had been settled for her admission to some 
asylum, when he was induced to consult me on the last day before 
her entering one. He stated tii;J fchfc paroxysms always eame on 
at li;ilt'-]u.-i a vi- of six every evening: I replied, if the attacks 
depended on peripheral irritation, that an operation would at once 



80 



prevent recurrence of the attacks. She was accordingly admit 
into the London Surgical Home Feb. r>, 1884, 

When admitted, said she had taken no food for three days, an 
asked for a cup of tea, which was given her. Enema was i 
administered. 

3.45 p.m. Was seized with a fit, throwing her arins up 
her head, and then appearing as if comatose. In about twenty 
minutes revived : the lips began to quiver, and she gradua 
became conscious, saying, u I want a knife— I want bloud | ■ 
asked for the matron's hand, that she might bite it off. 

[The fit coming on earlier on this day was doubtless due 
excitement consequent on her removal] 

5 p,m. Mr. Baker Brown saw her ; as soon as he came ne 
her, she seized his shoulder with great violence ; was wild, i 
would not answer questions ; but gradu ne southed, i 

allowed nit examination. 

Esftrntilhji the abdomen showed signs of a child having been 
born, and the nianmue had certainly contained milk. The clitv 
was enlarged and hard ; the injmphw long and llabby ; the mucou 
membrane roughened and discoloured. 

Per vagiitam, the uterus was found to be retro verted ; there was 
also a fissure of the rectum. 

Operation^ 5.30 p.m. Was very violent under the first attempts 
to administer chlurof ornL She was long in being brought under 
its influence, but when once thoroughly anesthetized, bore it 
exceedingly welL 

The clitoris was excised, the elongated nvniphre removed, .mil 
the fissure of the rectum divided. The wounds were tire* 
the usual manner, and the patient having had two grains of opium 
administered, mi ordered to be constantly watched. 

In tw* 'ii ty minutes awoke from the chloroform. Was calm, and 
slept at intervals during the night. 

Feb. 7, 10 a*m. Visited by Mr. B. Brown, Present— Mr. L Bw 

Blown, junior, House-Surgeon, and Matron. Pnlse quick but 

; tongue brown and fum h offensive ; gums spongy ; 

pupil natural ; countenance rather flushed ; skin moist and warn, 



81 



The following answers were given to questions asked of her by 
Mr, Brown, seventeen hours after operation, and are in her own 
words ; much, however, of the information was volunteered without 
questions : — 

'* Last March, instead of sliding down a slope, I jumped* This 
caused displacement of my womb. I suffered great agonies. I 
was fomented with hot water, I thought it was my back that 
was hurt. Since then I have been subject to fainting and weak- 
ness. I suffer great irritation about my private i»urts— cannot 
keep my hands away. The irritation is worse at night, I aiu 
obliged to relieve the irritation by rubbing — sometimes for two or 
three minutes at a time. There is always a discharge, I feel 
very depressed afterwards. At times I have lost my brain, and 
felt as if I did not care for Eving. I woidd like to have my b 
untied ; I will be very quiet. Have been separated from my 
relatives for three years. I shan't tell you how long I have been 
married — (a pause). I am very rude — I beg your pardon. I have 
been married three years. I had a baby two years ago : it was 
not born at the full time — I think five month*. I don't know 
whether it was alive. I left home with tny friend when I was 
sixteen (?). It is two years since I left him. I am now twenty- 
three. 

*' After the accident, suffered great pain." Mr. Brown here 
looked at her gums, and she immediately said, " Oh t yes ; 1 had 
mercury given me by Surgeon — — , in Dublin : he said it 

my spine, lie did not examine my womb. Dr. examined 

it, and said there was great displacement. I nave been better for 
treatment at times. My brain bis been affected. I have fought 
very much. I have wanted a child's blood. I have had it some* 
times by sucking the wounds of a child. When in a fit, I don't 
know what is going on around, or what is being said T but I recog- 
nize people's voices. I am not regular. Was kept in bed last 
September for six weeks for flooding ; was so for ten days after I 
I 'lit in bed. Was the same in Paris last year. I was studying 
in P«rifl to tit myself for a governess." 

The following are extracts from a letter voluntarily sent to 



82 



Mr. Brown by a lady with whom the patient lived for many montl 
and left only three weeks previous to admission. Having stai 
that for some time fihe was hysterical, and becoming daily m 
excitfcbl&, the letter says — 

" On the 13th of September last, she for the first time see 
delirious when going to bed. This was mentioned next moral 

bo Burgeon * who declared it to be nervous irritability of 

spine. , . . On the 27th, Dr, — — was called in, and at oner 
his opinion that there was ailment of the womb. He then orde: 
small blisters on the lower part of the stomach, which in less 
ten hours relieved her, and removed the mania. She had not any 
reason for many days previous, and was sinking. ... On the 3rd 

of October, Dr. fixed an instrument to support the womb ; 

and, except during the time when the intensity of pain caused it, 
there was no delirium ; for a few days she got claret, which bi 
to excite her greatly, so it was discontinued ; but on the 13th of 
October I was desired to give her port wine in abundance. She 
was excessively weak, and mania so dreadful, that she made several 
attempts to injure herself and me. She got as many as eight la 
glasses of best port on some days ; strong beef-tea, chicken sou 
and all the nourishment possible. It was not only suggested, but 
it was advised to remove her to a lunatic asylum ; however, feeling 
that certainly nine-tenths of her time she was perfectly sane, and 
could know well where she was and with whom, I did not Eke the 
idea of placing so young a creature in an asylum, I kept her here, 
and watched her day and night \ she never was left, alone for one 
moment for three months. . , . I ought to mention that the oi 
for abundance of wine, &c, was from the opinion that ; want 
blood to the brain' caused the mania ; and that the intense 
nVtmmation of all internal organs was relieved by blisters on 
lower part of the stomach and by mercury.' 1 

Feb. 8. Lint removed from rectum, and wounds dr> 
calm and rational ; pasted a quiet day. 

Feb. 10, Very restless ; obliged to restrain hands and legs. 

Feb. 1L Better; says her bead feels heavy; countenatii 
cheerful ; manner quiet and rational. 



j ral 

z 

up, 



83 



Feb, 12. Very excited and irritable ; constantly miijiiigiug to 
her hands ; will allow no one near her,— 2 p.m. : Is quite 
maniacal ; has managed to Irritate the wounds, and also tin* 
maiiiiufe, To have one grain of opium in pill, and ten grains of 
bromide of ammonium three times a day. 

Feb, 13, 6 GkVQU Hands again free ; repeat opium. Slept after- 
wards till 4 p.m., when she awoke calm ami rational, — p.m. Slept 
again. 

Feb. 14. Very restless, and at times violent. Bandages removed 
and jacket substituted. 

Feb. 15. Much better ; rational, and conversing cheerfully. 

Feb. 16. Improving. 

Feb. 17. At her urgent request, hands were freed, but shortly 
after she became excited. 

Feb. 19. More sensible ; had to-day symptoms of a severe 
bilious attack, which upset her for some days. 

Feb. 24 Much better ; allowed to see her sister — the first tune 
since the operation. 

March 1 . Much improved ; has written to her sister, and amused 
herself knitting and reading during the day. 

March 2. Allowed to dress ; seemed to enjoy the change, and 
is very rluvs-f'sil. 

March 4 Visited by her sister ; has been quietly cheerful all 
day. Is certainly improving wonderfully. 

March SO. Took a walk, and enjoyed it 

March 25, Spent the day away from the Home with her sister ; 
returned looking quite well, and all the better for the change. 

April 2, Discharged quite cured. 

This patient remained perfectly well, and I hear has since been 
legally married. 



84- 



Case XL VEX Incipient Mania— One Teak's Dura- 
tion— OrERATION — CUBE SUBSEQUENT PREGNANCY. 

in 1863, Mrs, S. M., married, mother of three children, m 
came under mv cue, because she had been suffering for more than 
a year from Menorrhagia, which had gradually affected her mind, 
causing her to have a great distaste for her husband ; so much so, 
that he and his Mends were induced seriously to contemplate 
separation* On the first examination, her feoe oienl 

disturbance, eyes restless, pupils dilated, and manner generally 
excitable. She told me that she could not sleep at night, com- 
plained of constant weary uneasiness in her womb, pain in her 
back, great pain on defecation, constant desire to micturate. She 
said she was glad to be away from home, as she made every one 
around her unhappy* Believed that she would be a permanently 
insane patient, and never expected to return to lier family again. 

On more minute examination, I found irritable clitoris and labia, 
a painful fissure of the rectum, with great relaxation of the sphincter 
nni, which, on inquiry, was found to be caused by the frequent 
introduction of her finger, with a view to peripheral irritation. At 
her own request, she had long been separated a mmsd from her 
husband, on account of her gr< for him and cohabitatioi 

with him. 

I pursued the usual surgical treatment, which was followed 
uninterrupted success ; and after two months' treatment, she 
turned to her husband, resiuned cohabitation, and stated that 
her distaste had disappeared ; soon became pregnant, resumed 
place at the head of her table, and became a happy and heal 
wife and mother. She was in due time safely delivered, and 
ever since remained u\ perfect health. 

M&marhs. — From observations of this case, one feels compelled 
to say, may not it be typical of many others where there is a judicial 
separation of husband and wife, with all the attendant domestic 
miseries, and where, if medical and surgical treatment were brought 
to bear, all such unhappy measures would be obviated ? 



llv 




85 

A careful perusal of the cases related in the 
foregoing pages will show that all the theoretical 
objections mentioned -in the introductory chapter, as 
having been raised against my treatment, have been 
fully contradicted by facts. Of the permanency of 
the result, I myself am fully satisfied ; and I hope at 
a future time, by a much larger number of cases, to 
confirm others in the same opinion. 



COX AND WYMAN, PRIKTER8, GREAT QUEEN STREET, W.C.